Trends and Safety of Same-day Discharge for Robot-assisted Laparoscopic Prostatectomy: A Comparison Between the Pre-pandemic and Pandemic Periods From the National Cancer Database

Objective

To assess and compare the use of same-day discharge (SDD) for robot-assisted laparoscopic prostatectomy (RALP) between the "Pre-pandemic" and "Pandemic" periods and investigate SDD impact on mortality and readmissions.

Materials and Methods

We examined data from the National Cancer Database on men receiving RALP in the “Pre-pandemic” (2018-2019) and “Pandemic” (2020) periods. We analyzed the differences in patient and hospital characteristics between SDD and non-SDD patients. Multivariable logistic regression analysis was performed to evaluate the likelihood of SDD during "Pandemic" versus "Pre-pandemic" periods. Inverse probability treatment weighting (IPTW) was utilized to assess the impact of SDD on 30-day mortality, 90-day mortality, and 30-day readmissions, adjusting for patient and hospital characteristics.

Results

Out of 111,117 men, 8997 (8%) received SDD. Patients with more comorbidities, non-private insurance, and high-risk prostate cancer reported lower SDD rates (P <.001). Higher SDD rates were observed at academic facilities and those in the top RALP volume quartile (P <.001). Patients who underwent RALP during the "Pandemic" period had increased odds of SDD compared to those receiving RALP in the "Pre-pandemic" period (aOR 1.37; 95%CI 1.31-1.45; P <.001). When comparing SDD and non-SDD patient outcomes, after IPTW adjustment, there was no difference in the odds of 30-day mortality (aOR 0.98; 95%CI 0.47-2.01; P = .95), 90-day mortality (aOR 1.09; 95%CI 0.60-1.97; P = .76), or 30-day readmissions (aOR 0.90; 95%CI 0.76-1.06, P = .21).

Conclusion

SDD for RALP increased steadily after pandemic. Identifying factors and necessary resources to standardize SDD for RALP will be crucial for its widespread adoption in the coming years.