Trends and Safety of Same-day Discharge for Robot-assisted Laparoscopic Prostatectomy: A Comparison Between the Pre-pandemic and Pandemic Periods From the National Cancer Database - 09/11/24

Doi : 10.1016/j.urology.2024.10.049

Filippo Dagnino ^a,^b,^c,^d,^{^{1
Filippo Dagnino and Muhieddine Labban contributed equally}}, Muhieddine Labban ^a,^b,^{^{1
Filippo Dagnino and Muhieddine Labban contributed equally}}, Brittany Berk ^a,^b, Zhiyu Qian ^a,^b, Daniel Stelzl ^a,^b,^e, Hanna Zurl ^a,^b,^f, Stephan Korn ^a,^b,^g, Giovanni Lughezzani ^c,^d, Nicolò M. Buffi ^c,^d, Alexander P. Cole ^a,^b, Adam S. Kibel ^a, Quoc-Dien Trinh ^a,^b, Kathy G. Niknejad ^a,^⁎
^a Department of Urology Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
^b Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
^c Department of Urology, Humanitas Research Hospital—IRCCS, Milan, Italy
^d Department of Biomedical Sciences, Humanitas University, Milan, Italy
^e Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
^f Department of Urology, Medical University of Graz, Graz, Austria
^g Department of Urology, Medical University of Vienna, Vienna, Austria

^⁎Address correspondence to: Tasha Posid, M.A., Ph.D., Department of Urology, Chief Medical Office, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02215Department of Urology, Chief Medical Office, Brigham and Women’s Hospital75 Francis StBostonMA02215

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 09 November 2024

Résumé

Objective

To assess and compare the use of same-day discharge (SDD) for robot-assisted laparoscopic prostatectomy (RALP) between the "Pre-pandemic" and "Pandemic" periods and investigate SDD impact on mortality and readmissions.

Materials and Methods

We examined data from the National Cancer Database on men receiving RALP in the “Pre-pandemic” (2018-2019) and “Pandemic” (2020) periods. We analyzed the differences in patient and hospital characteristics between SDD and non-SDD patients. Multivariable logistic regression analysis was performed to evaluate the likelihood of SDD during "Pandemic" versus "Pre-pandemic" periods. Inverse probability treatment weighting (IPTW) was utilized to assess the impact of SDD on 30-day mortality, 90-day mortality, and 30-day readmissions, adjusting for patient and hospital characteristics.

Results

Out of 111,117 men, 8997 (8%) received SDD. Patients with more comorbidities, non-private insurance, and high-risk prostate cancer reported lower SDD rates (P <.001). Higher SDD rates were observed at academic facilities and those in the top RALP volume quartile (P <.001). Patients who underwent RALP during the "Pandemic" period had increased odds of SDD compared to those receiving RALP in the "Pre-pandemic" period (aOR 1.37; 95%CI 1.31-1.45; P <.001). When comparing SDD and non-SDD patient outcomes, after IPTW adjustment, there was no difference in the odds of 30-day mortality (aOR 0.98; 95%CI 0.47-2.01; P = .95), 90-day mortality (aOR 1.09; 95%CI 0.60-1.97; P = .76), or 30-day readmissions (aOR 0.90; 95%CI 0.76-1.06, P = .21).

Conclusion

SDD for RALP increased steadily after pandemic. Identifying factors and necessary resources to standardize SDD for RALP will be crucial for its widespread adoption in the coming years.

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