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UPJ INSIGHT Outpatient vs Inpatient Single-Port Robotic Urologic Surgery: Perioperative Outcomes and Complications
By: Antony A. Pellegrino, MD, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy, University of Illinois at Chicago; Ruben Sauer Calvo, MD, University of Illinois at Chicago; Francesco Pellegrino, MD, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy; Luca Morgantini, MD, University of Illinois at Chicago; Alberto Briganti, MD, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy; Francesco Montorsi, MD, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy; Simone Crivellaro, MD, MHA, University of Illinois at Chicago | Posted on: 20 Mar 2024
Pellegrino AA, Calvo RS, Pellegrino F, et al. Outpatient vs inpatient single-port robotic urologic surgery: perioperative outcomes and complications. Urol Pract. 2024;11(2):422-429.
Study Need and Importance
The advent of the da Vinci Single Port (SP) robotic system, further minimizing minimally invasive surgery, has presented an opportunity to make robotic outpatient procedures consistent. That said, there is a need to evaluate the safety and feasibility of this care scheme prior to considering its potential to reduce costs and enhance patient experience. Our study aimed to fill this gap by assessing the perioperative outcomes of outpatient SP robotic urologic surgery compared to inpatient procedures.
What We Found
Our study, conducted on 374 patients from a high-volume center, revealed promising results. Outpatient SP surgery was not associated with increased postoperative complications or readmissions when compared to inpatient surgery. By the end of the study period in February 2023, 88% of patients achieved successful same-day discharge (SDD; Figure). Importantly, SDD did not lead to a missed detection of serious early complications, as most postoperative complications occurred after the third postoperative day.
Limitations
While our study showcases the potential benefits of outpatient SP surgery, it has certain limitations. It primarily reflects the experience of a single surgeon and might not be fully generalizable to all centers. Additionally, there’s a temporal bias in the distribution of cases between outpatient and inpatient surgery, which may have affected the incidence of complications, as the outpatient scheme was adopted only later in the SP learning curve.
Interpretation for Patient Care
This pilot study confirms the safety and feasibility of SDD for patients undergoing SP robotic urologic surgery. This model has the potential to reduce health care costs, improve patient experience, and free up hospital resources. It is essential for patients to be educated about the benefits and expectations of SDD, with the availability of a caregiver being a crucial factor. Future research should explore the factors influencing SDD success in various urologic procedures to optimize patient care further.
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