Protocol-driven same day discharge for robotic radical prostatectomy.

PURPOSE: Average length of stay following robot-assisted laparoscopic prostatectomy (RALP) ranges from 24 to 48 hours. This study evaluates the implementation, safety, and efficacy of a standardized same-day discharge (SDD) protocol for RALP patients compared to inpatient stay.

MATERIALS AND

METHODS

We conducted a retrospective cohort study of 220 patients who underwent RALP at a single academic center from January 2022 to September 2023. We implemented a standardized SDD protocol on August 1, 2022, expanding eligibility criteria and formalizing perioperative management. Patients were categorized into same-day discharge (SDD) or inpatient (IP-RALP) groups for analysis. Categorical endpoints were compared between cohorts with Fisher's exact tests while continuous outcomes were compared with Wilcoxon rank sum tests.

RESULTS

220 males underwent RALP, with 132 (88.6%) of 149 SDD-initiated patients successfully discharged on the same day. Outcomes including ED visits, 30-day readmission rates, were similar between groups, with no significant differences observed in 24-hour readmissions (SDD 0.8%, IP-RALP 0%, P > 0.99). While 30-day readmissions were slightly higher in SDD (9.1% vs. 4.6%), this was not statistically significant (P = 0.29). Complication rates and number of follow-up calls were similar across cohorts. Formal SDD protocol implementation improved POD1 contact rates (48% vs. 73.8%, P = 0.01) and consistency in discharge medication management.

CONCLUSIONS

Our findings suggest SDD after prostatectomy is safe, with no observed increased risk of ED visits, readmissions, or complications compared to IP-RALP. Formal SDD protocol implementation improved consistency in discharge processes. Future studies are needed to further elucidate preoperative risk stratification for appropriate tailoring of protocol driven care.