Is 23-h discharge following robotic radical prostatectomy and partial nephrectomy feasible and safe in a quaternary care center in a developing country?

Abstract

Introduction: Robot-assisted radical prostatectomy (RP) or partial nephrectomy (PN) is often a daycare or overnight procedure in developed countries. This study assesses the safety and feasibility of discharging patients within 23 h after surgery in a developing country.

Methods: This retrospective cohort study examined patients who underwent RP and PN between June 2022 and December 2023. We analyzed the clinical-pathological profiles of patients discharged within 23 h after surgery versus later. A single surgeon performed all surgeries, and an early recovery protocol was practiced.

Results: Out of 71 PN patients, 62 (87.3%) were discharged within 23 h (of which, nine were discharged the same evening); the median stay for others was 3 days. Four patients had complications that delayed discharge, and one required readmission. Among 28 RP patients, 20 (71.5%) were discharged within 23 h; the median stay for others was 3 days. Two patients with complications had delayed discharge. There were no 30-day readmissions in the RP cohort. Factors such as comorbidities, American Society of Anesthesiologists grade, and tumor staging did not predict discharge timing in either the RP or PN cohort. Furthermore, none required blood transfusions or conversion to open surgical procedures, and there were no recorded fatalities in either cohort.

Conclusions: Twenty-three-hour discharge following robot-assisted RP and PN demonstrated both safety and feasibility in a developing country, which is contingent upon the implementation of an early recovery protocol in a tertiary or quaternary care setting. Effective preoperative counseling and interdepartmental communication are essential for success.