Same-day Discharge versus Inpatient Robotic Assisted Radical Prostatectomy: Complications, Time-Driven Activity-Based Costing, and Patient Satisfaction.
Academic Article
Overview
abstract
PURPOSE: Historically, robotic assisted radical prostatectomy (RARP) is accompanied by an inpatient hospital admission. The COVID-19 pandemic necessitated a transition to same-day discharge RARP in some centers to free up critically needed inpatient beds. This study aims to compare complications, total healthcare costs, and patient satisfaction for same-day discharge vs inpatient RARP. MATERIALS AND METHODS: We compared 392 consecutive RARPs performed as same-day discharge (n=206) vs inpatient (n=186) from February 2020 to November 2022 at 2 academic medical centers. We utilized propensity score analysis to assess the impact of same-day discharge vs inpatient RARP on 30-day complications (primary outcome). Time-driven activity-based costing (TDABC) analysis was applied to compare total costs of RARP care, and we administered a validated Patient Satisfaction Outcome Questionnaire (PSOQ) to compare satisfaction scores. RESULTS AND CONCLUSIONS: Inpatient RARP patients were more likely to be older, self-reported Black race or Hispanic ethnicity, and have higher American Society of Anesthesiologists (ASA) classification. Complication rates were non-significantly lower for same-day discharge vs inpatient RARP (Odds Ratio [OR] 0.87, 95% Confidence Interval [CI] 0.35 to 2.21; P = .8). Same-day discharge vs inpatient RARP demonstrated a $2,106 (199%) overall cost reduction. Median satisfaction survey scores were similar and a clinically significant difference can be excluded. Same-day discharge RARP is cost-effective and should be the preferred approach in appropriately selected patients.
