Introduction: Same-day discharge (SDD) following robot-assisted radical prostatectomy (RARP) is emerging as a standard of care. We conducted a systematic review and meta-analysis to summarize published pathways and to evaluate the differences in perioperative characteristics, complication rates, and satisfaction/cost data between in-patient (IP) RARP and SDD-RARP.

Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered with PROSPERO. A comprehensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and conference abstract publications was performed comparing outcomes between IP-RARP and SDD-RARP. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias.

Results: A total of 14 studies (eight prospective and six retrospective cohort studies) were included, with a pooled population of 3795 patients, including 2348 (61.9%) IP-RARPs and 1447 (38.1%) SDD-RARPs. SDD pathways varied, though many commonalities were present in patient selection (minimal comorbidities), perioperative recommendations (judicious intra-operative fluids and short-acting narcotics), and postoperative management (immediate ambulation and diet, and non-narcotic analgesia). When compared to IP-RARP, SDD-RARP had no differences in ≥grade 3 Clavien–Dindo complications (relative risk [RR] 0.4, 95% confidence interval [CI] 0.2, 1.1), 90-day readmission rates (RR 0.6, 95% CI 0.3, 1.1), or unscheduled emergency department visits (RR: 1.0, 95% CI 0.3, 3.1). Cost savings per patient ranged from $466–2678 CAD, and overall satisfaction was high, between 87.5–100%.

Conclusions: SDD following RARP is both feasible and safe while offering healthcare cost-savings with high patient satisfaction rates. Data from this study will further inform the uptake and development of future SDD pathways in contemporary urological care such that it may be offered to a broader Canadian population.