Same Day Discharge after Robotic Radical Prostatectomy
Same Day Discharge after Robotic Radical Prostatectomy
复制标题
机器人辅助根治性前列腺切除术后当日出院
DOI：
10.1097/ju.0000000000000353
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发表时间：
2019-11-01
影响因子：
6.6
通讯作者：
Gerhard, Robert S.
中科院分区：
文献类型：
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作者：
Abaza, Ronney;Martinez, Oscar;Gerhard, Robert S.
目的：机器人辅助的腹腔镜前列腺摘除术后平均住院时间为24至48小时。在机器人辅助的腹腔镜前列腺切除术后，我们开始例行当天出院。我们评估了成功率、安全性和成本影响，据我们所知，这是迄今为止唯一一次大规模的当天出院。材料和方法：从2016年9月开始，所有患者都可以选择当天出院，而不是强制这样做。3个月后，我们评估了接下来500名患者的前瞻性数据库。结果：在由一名外科医生在18个月内接受机器人辅助腹腔镜前列腺切除术的500名男性患者中，246人(49.2%)在手术当天出院，其余254人第二天全部出院，平均住院时间为0.51天。平均年龄62岁(42~81岁)，平均体重指数29.7 kg/m(2)(20~53岁)。其中34例(6.8%)在90天内出现Clavien-Dindo I-III级并发症，但无IV-V级并发症。只有5名患者(1%)需要急诊科就诊，只有8名(1.6%)需要再次住院。选择当天出院的患者中只有1人再次住院，只有1人到急诊科就诊。在我们机构过夜的费用估计是2109美元。费用在18个月期间大约减少了518,814美元(每年345,876美元)，与过夜病人相比，没有因急诊科就诊或重新住院而增加费用。在最近的100例患者中，当天出院率提高到65%。结论：机器人辅助腹腔镜前列腺切除术后的当天出院是安全的，而不会增加再入院或紧急就诊的次数。这可能会显著节省医疗成本。
Purpose: The typical mean length of stay following robot-assisted laparoscopic prostatectomy is 24 to 48 hours. We began routinely offering same day discharge from the hospital after robot-assisted laparoscopic prostatectomy. We evaluated the success rate, safety and cost implications in what is to our knowledge the only large series of same day discharge to date.Materials and Methods: Beginning in September 2016 all patients were given the option of same day discharge without it being mandated. After allowing 3 months to solidify the protocol we evaluated our prospective database for the next 500 patients.Results: Of the 500 consecutive men who underwent robot-assisted laparoscopic prostatectomy performed by 1 surgeon in 18 months 246 (49.2%) were discharged home the day of surgery and all of the remaining 254 were discharged the next day for a mean 0.51-day length of stay. Mean patient age was 62 years (range 42 to 81) and mean body mass index was 29.7 kg/m(2) (range 20 to 53). Of the patients 34 (6.8%) had a Clavien-Dindo grade I-III complication within 90 days but there were no grade IV-V complications. Only 5 patients (1%) required an emergency department visit and only 8 (1.6%) required readmission. Only 1 of the patients who elected same day discharge was rehospitalized and only 1 presented to the emergency department. The estimated charge for an overnight stay at our institution is $2,109. The approximate reduction in charges was $518,814 during 18 months ($345,876 per year) with no increased cost due to emergency department visits or hospital readmissions compared with that of overnight patients. In the most recent 100 patients the rate of same day discharge improved to 65%.Conclusions: Same day discharge following robot-assisted laparoscopic prostatectomy can be safely routinely offered with no increase in readmissions or emergency visits. It may lead to significant savings in health care costs.