Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;210(6):856-864.
doi: 10.1097/JU.0000000000003678. Epub 2023 Aug 28.

Same-Day Discharge vs Inpatient Robotic-Assisted Radical Prostatectomy: Complications, Time-Driven Activity-Based Costing, and Patient Satisfaction

Emily Cheng  1 , Sofia Gereta  2 , Tenny R Zhang  1 , Alec Zhu  1 , Spyridon P Basourakos  1 , Chunmei McKernan  1 , Siwen Xie  1 , Andrew J Vickers  3 , Aaron A Laviana  2 , Jim C Hu  1
Affiliations

Same-Day Discharge vs Inpatient Robotic-Assisted Radical Prostatectomy: Complications, Time-Driven Activity-Based Costing, and Patient Satisfaction

Emily Cheng et al. J Urol. 2023 Dec.

Abstract

Purpose: Historically, robotic-assisted radical prostatectomy is accompanied by an inpatient hospital admission. The COVID-19 pandemic necessitated a transition to same-day discharge robotic-assisted radical prostatectomy in some centers to free up critically needed inpatient beds. This study aims to compare complications, total health care costs, and patient satisfaction for same-day discharge vs inpatient robotic-assisted radical prostatectomy.

Materials and methods: We compared 392 consecutive robotic-assisted radical prostatectomies performed as same-day discharge (n = 206) vs inpatient (n = 186) from February 2020 to November 2022 at 2 academic medical centers. We utilized propensity score analysis to assess the impact of same-day discharge vs inpatient robotic-assisted radical prostatectomy on 30-day complications (primary outcome). Time-driven activity-based costing analysis was applied to compare total costs of robotic-assisted radical prostatectomy care, and we administered a validated Patient Satisfaction Outcome Questionnaire to compare satisfaction scores.

Results: Inpatient robotic-assisted radical prostatectomy patients were more likely to be older, self-reported Black race or Hispanic ethnicity, and have higher American Society of Anesthesiologists classification. Complication rates were nonsignificantly lower for same-day discharge vs inpatient robotic-assisted radical prostatectomy (OR 0.87, 95% CI 0.35 to 2.21; P = .8). Same-day discharge vs inpatient robotic-assisted radical prostatectomy demonstrated a $2106 (19%) overall cost reduction. Median satisfaction survey scores were similar, and a clinically significant difference can be excluded.

Conclusions: Same-day discharge robotic-assisted radical prostatectomy is cost-effective and should be the preferred approach in appropriately selected patients.

Keywords: ambulatory care; costs and cost analysis; prostatectomy; prostatic neoplasms.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None

Comment in

  • Editorial Comment.
    Oberlin D. Oberlin D. J Urol. 2023 Dec;210(6):862-863. doi: 10.1097/JU.0000000000003678.01. Epub 2023 Sep 25. J Urol. 2023. PMID: 37747132 No abstract available.
  • Editorial Comment.
    Filipas DK, Beatrici E, Trinh QD. Filipas DK, et al. J Urol. 2023 Dec;210(6):863. doi: 10.1097/JU.0000000000003678.02. Epub 2023 Sep 25. J Urol. 2023. PMID: 37747138 No abstract available.

References

    1. Halpern JA, Shoag JE, Artis AS, et al. National trends in prostate biopsy and radical prostatectomy volumes following the us preventive services task force guidelines against prostate-specific antigen screening. JAMA Surg 2017;152(2):192–198. doi:10.1001/jamasurg.2016.3987 - DOI - PubMed
    1. Martini A, Marqueen KE, Falagario UG, et al. Estimated Costs Associated With Radiation Therapy for Positive Surgical Margins During Radical Prostatectomy. JAMA Netw open 2020;3(3):e201913. doi:10.1001/jamanetworkopen.2020.1913 - DOI - PMC - PubMed
    1. Crew B Worth the cost? A closer look at the da Vinci robot’s impact on prostate cancer surgery. Nature 2020;580(7804):S5–S7. doi:10.1038/d41586-020-01037-w - DOI
    1. Oberlin DT, Flum AS, Lai JD, Meeks JJ. The effect of minimally invasive prostatectomy on practice patterns of American urologists. Urol Oncol Semin Orig Investig 2016;34(6):255.e1–255.e5. doi:10.1016/j.urolonc.2016.01.008 - DOI - PMC - PubMed
    1. Banapour P, Elliott P, Jabaji R, et al. Safety and feasibility of outpatient robot-assisted radical prostatectomy. J Robot Surg 2019;13(2):261–265. doi:10.1007/s11701-018-0848-8 - DOI - PubMed

Publication types