1628 BASELINE FUNCTIONAL STATUS IS PREDICTIVE OF DECISIONAL REGRET AND SATISFACTION FOLLOWING ROBOTIC PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Knowledge of patient satisfaction or regret following definitive management of localized prostate cancer is an important but under-evaluated element in comprehensive patient counseling. METHODS: 703 of 953 consecutive patients presenting for follow-up after robotic-assisted laparoscopic prostatectomy (RALP) completed validated measures of HRQOL and treatment-decision satisfaction and regret. Questionnaires were administered a median of 15.2 months (IQR: 7.5-25.9) after surgery. Clinicopathologic, perioperative, and functional outcomes were analyzed with univariable and multivariable models to uncover associations with patient decisional satisfaction and regret. RESULTS: Mean decisional regret score was 87.7 while mean decisional satisfaction score was 87.6 (100 point scale, higher scores better HRQOL) suggesting that patients were mostly satisfied with their decision to undergo RALP. Baseline HRQOL, specifically baseline urinary function was independently predictive of post-operative satisfaction and regret. Post-operative erectile dysfunction, incontinence and length of stay 2 days were significantly associated with both decisional regret and satisfaction, Increasing post-operative pad usage (from 0 to 1 to 2) led to progressively lower decisional satisfaction scores. However, there was no difference in decisional regret or satisfaction between those with post-operative SHIM of 17-21 and those 22 (see table). In multivariable analysis, preoperative continence, and postoperative erectile function and continence were significant predictors of both decisional regret and satisfaction. Race and length of stay were predictive of regret, while time from surgery was a predictor of decisional satisfaction. Preoperative cancer risk, histopathologic and short term biochemical outcomes were unrelated to decisional regret. CONCLUSIONS: Baseline functional status and functional outcomes are independent predictors of decisional satisfaction and regret following RALP. This information may be useful to urologists during preoperative patient counseling to set realistic expectations for the post-operative course, potentially improving the surgical experience.