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UPJ INSIGHT Preoperative Optimization of Promotility in Robotic Prostatectomy and Minimally Invasive Kidney Surgery
By: Derek Jensen, MD; Alexandra Dahlgren; Katie Glavin; Paul Black, MS; David Duchene, MD; William P. Parker, MD; Moben Mirza, MD, FACS; Jeffrey M. Holzbeierlein, MD, FACS; Eugene K. Lee, MD | Posted on: 01 May 2022
Jensen D, Dahlgreen A, Glavin K et al: Preoperative optimization of promotility in robotic prostatectomy and minimally invasive kidney surgery. Urol Pract 2022; https://doi.org/10.1097/UPJ.0000000000000295.
Study Need and Importance
There remains a subset of patients who experience a delay in discharge following prostate and kidney surgery despite minimally invasive surgery techniques. Although the reasons for delayed discharge can be multifactorial, they often consist of gastrointestinal-related symptoms. Despite this, there is little known about the baseline preoperative level of constipation symptoms in this patient population, which could be exacerbating postoperative gastrointestinal complaints and contributing to delays in discharge.
Table. Median preoperative PAC-SYM score and length of stay (LOS) by procedure type
| Median (IQR) | Mean | |
| Preop PAC-SYM score: | ||
| Overall | 2 (0–7.5) | 4.4 |
| Prostatectomy | 2 (0–5.5) | 4.2 |
| Partial nephrectomy | 2 (0–7) | 4.1 |
| Radical nephrectomy | 4 (1–9) | 4.8 |
| Pts with LOS 2 days | 2 (2–9) | 4.1 |
| Pts with LOS >2 days | 4 (0–7.5) | 5.5 |
| LOS (days): | ||
| Overall | 2 (2–2) | 2.2 |
| Prostatectomy | 2 (2–2) | 2.0 |
| Partial nephrectomy | 2 (2–2.5) | 2.3 |
| Radical nephrectomy | 2 (2–3) | 2.4 |
What We Found
We administered the validated Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire preoperatively in 97 patients undergoing minimally invasive kidney or prostate surgery and found that a majority (69%) of patients reported constipation symptoms before surgery. Patients who experienced a delay in discharge from the hospital also had significantly higher median preoperative PAC-SYM scores (see table) compared to those who were discharged on time. The association was significant for delays due to gastrointestinal symptoms (p=0.032) as well as delay for any cause (p=0.021).
Limitations
Although this study was prospective, it was conducted at a single institution and observational. More evidence is needed to determine if there is a causal relationship between preoperative PAC-SYM scores and delays in discharge.
Interpretation for Patient Care
Preoperative constipation symptoms are common in patients undergoing minimally invasive urological surgery and likely underrecognized. Delays in hospital discharge were associated with higher levels of symptom burden. Preoperative baseline gastrointestinal dysmotility may represent a modifiable preoperative risk factor for delays in discharge following these procedures.
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