Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care.

Abstract

Purpose: To compare the perioperative characteristics of patients receiving outpatient vs inpatient care and to define predictors of inpatient care after single-port extraperitoneal robotic radical prostatectomy (RRP). Patients and Methods: Data on 120 patients who underwent single-port extraperitoneal RRP were collected and categorized into two groups: Group I (n = 98) included patients who received outpatient care (i.e. discharged on postoperative day 0) and Group II (n = 22) comprised patients with inpatient care. Demographics and perioperative data were recorded and analyzed between the two groups. Multivariable binary logistic regression was used to determine factors associated with inpatient care. Results: Most patients (98/120: 81.7%) were discharged in few hours (median: 4.1 hours) after surgery (outpatient care: Group I [n = 98]), whereas others (Group II [n = 22]) received inpatient care (median hospital stay: 25.4 hours); p < 0.00001. Most patients with inpatient care (13/22, 59.1%) were among the first initial 40 cases, whereas 37 out of last 40 patients received outpatient care (p = 0.005). Operative time was significantly shorter in patients with outpatient prostatectomy (p = 0.015). The amount of narcotics per patient (if administered) was also significantly greater in Group II (p = 0.006). With regression analysis, having medical comorbidities (odds ratio [OR]: 3.41 95% confidence interval [CI]: 2.05-5.64; p = 0.014), a longer operative time (OR: 1.15 95% CI: 1.10-1.28, p = 0.017), as well as a higher dose of administered narcotics after operation (OR: 1.31 95% CI: 1.08-1.61, p = 0.005) were significant predictors of inpatient care after single-port extraperitoneal RRP. Conclusion: A safe transition to outpatient care is feasible in patients undergoing single-port extraperitoneal RRP. In addition to associated medical comorbidities, a longer operative time and the amount of received narcotic after procedure were the most significant predictors of prolong hospital stay after single-port extraperitoneal RRP. These later modifiable predictors can be optimized with improvement of surgical techniques, intraoperative and postoperative pain management protocols through quality improvement initiatives.