Performing urological inpatient procedures as same-day procedures during the COVID pandemic – a retrospective feasibility study
Nicolas Siron1, Anis Assad1, Naeem Bhojani1.
1Division of Urology, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada
Introduction: In line with provincial directives due to the COVID pandemic, certain urological procedures that are normally performed as inpatient procedures were performed as same-day procedures to reduce the usage of healthcare resources.[1][2] At our center, during the pandemic, we began performing robotic-assisted radical prostatectomy (RARP) and laser enucleation of the prostate (LEP) as outpatient surgeries. Recent literature has suggested that RARP and LEP are safe and feasible as same-day surgeries.[3][4][5][6] Our goal was to determine if there was a difference in patient outcomes in RARP and LEP patients operated as same-day surgery vs inpatient.
Methods: Patients operated for RARP or LEP between May 2020 and Decemeber 2021 were studied. Among RARP patients, 95 were identified as planned inpatient (PIP-RARP) and 43 planned same-day (PSDD-RARP). Among LEP patients, 30 were identified as planned inpatient (PIP-LEP) and 46 planned as same-day (PSDD-LEP). PSDD patients were compared to PIP patients for both patient groups, with primary outcomes being SDD failure, 30-day complication, and re-admission rates.
Results: General patient characteristics, such as age, American Society of Anesthesiology (ASA), and Revised Cardiac Risk Index (RCRI) did not differ between PSDD and PIP in both patient populations (Table 1). Of the PSDD-RARP patients, 74.4% were successfully discharged the day of surgery. The overall postoperative complication, 30-day emergency department (ED) visits, and re-admission rates were 18.6%, 18.6%, and 9.3% in PSDD-RARP patients vs.13.7% (p=0.63), 4.2% (p=0.01), 2.1% (p=0.14) for PIP-RARP, respectively. Of the PSDD-LEP patients, 63% were successfully discharged the day of the surgery. The overall postoperative complication, 30-day ED visits, and re-admission rates were 15.2%, 4.3%, and 0% in PSDD-LEP patients vs. 23.3% (p=0.56), 6.7% (p=1.0), 3.3% (p=0.83) for PIP-LEP, respectively (Tables 2, 3).
Conclusions: Same-day discharge for RARP and LEP is safe and feasible in select patients, with an acceptable and comparable complication rate.
[1] Ploussard G, Dumonceau O, Thomas L, et al. Multi-Institutional Assessment of Routine Same Day Discharge Surgery for Robot-Assisted Radical Prostatectomy. J Urol. 2020;204(5):956-961.
[2] Rahota RG, Salin A, Gautier JR, et al. Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study. J Clin Med Res. 2021;10(4). doi:10.3390/jcm10040661
[3] Teoh, J.Y., et al., A Global Survey on the Impact of COVID-19 on Urological Services. Eur Urol, 2020. 78(2): p. 265-275.
[4] Gouvernement du Québec, Bloc opératoire - Directives cliniques aux professionnels et au réseau pour la COVID-19, Santé et servies sociaux, Editor. 2020.
[5] Agarwal, D.K., et al., Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus, 2021.
[6] Assmus, M.A., et al., Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc). J Endourol, 2021.
