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JU INSIGHT Same-Day Discharge vs Inpatient Robotic-Assisted Radical Prostatectomy
By: Emily Cheng, BS, New York Presbyterian Hospital, Weill Cornell Medicine, New York; Sofia Gereta, MSHCT, University of Texas at Austin Dell Medical School; Tenny R. Zhang, MD, New York Presbyterian Hospital, Weill Cornell Medicine, New York; Alec Zhu, MD, New York Presbyterian Hospital, Weill Cornell Medicine, New York; Spyridon P. Basourakos, MD, New York Presbyterian Hospital, Weill Cornell Medicine, New York; Chunmei McKernan, BS, New York Presbyterian Hospital, Weill Cornell Medicine, New York; Siwen Xie, BS, New York Presbyterian Hospital, Weill Cornell Medicine, New York; Andrew J. Vickers, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Aaron A. Laviana, MD, MBA, University of Texas at Austin Dell Medical School; Jim C. Hu, MD, MPH, New York Presbyterian Hospital, Weill Cornell Medicine, New York | Posted on: 15 Dec 2023
Cheng E, Gereta S, Zhang TR, et al. Same-day discharge vs inpatient robotic-assisted radical prostatectomy: complications, time-driven activity-based costing, and patient satisfaction. J Urol. 2023;210(6):856-864.
Study Need and Importance
More than 50,000 patients undergo robotic-assisted radical prostatectomy (RARP) annually in the United States. RARP is traditionally followed by inpatient admission, but the hospital bed shortage caused by the COVID-19 pandemic prompted a transition to same-day discharge after surgery. We compared complications, total health care costs, and patient satisfaction for same-day discharge vs inpatient RARP.
What We Found
Of 392 RARPs performed at 2 academic medical centers from February 2020 to November 2022, 206 patients were discharged on the same day and 186 were admitted as inpatients. Inpatient RARP patients were more likely to be older, of self-reported Black race or Hispanic ethnicity, and have higher American Society of Anesthesiologists classification. Using propensity-score analysis, complications were similar for same-day discharge vs inpatient RARP (OR 0.87, 95% CI 0.35-2.21, P = .8). A validated patient satisfaction questionnaire administered within 30 days after RARP showed no significant differences in pain or satisfaction. Time-driven activity-based costing analysis demonstrated that same-day discharge RARP saved $2106 in costs compared to inpatient stay (Figure).
Limitations
The 2 academic centers in this study used different criteria for same-day discharge, served different populations, and involved surgeons of varying experience. However, despite these variations, which strengthen the study design, we demonstrate similar outcomes. Additionally, time-driven activity-based costing analysis did not capture the indirect savings of same-day discharge RARP freeing up hospital beds for other diagnoses and conditions.
Interpretation for Patient Care
Our study is the first to show same-day discharge after RARP lowered health care costs by 19% without affecting 30-day complications or patient satisfaction. Same-day discharge after RARP demonstrates improved value-based (outcomes/costs) care delivery and should be preferred in appropriately selected patients.
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