Predictive factors for opioid-free management after robotic radical prostatectomy: the value of the SP® Robotic Platform.

BACKGROUND The objective was to evaluate perioperative factors associated with opioid-free management after robotic radical prostatectomy in a single institution. METHODS From January 2019 to January 2020, data from patients who underwent robotic radical prostatectomy was retrospectively entered in a pre-approved IRB database. Data were analyzed according to the postoperative opioid administration in hospital and/or after discharge. Robotic radical prostatectomy was performed using either the standard multi-port Da Vinci Si robotic platform with a transperitoneal approach(MP-RALP) or the novel DaVinci SP® robotic platform with an extraperitoneal approach(SP-EPP). Patients undergoing minimally invasive surgery were included in the "enhanced recovery after surgery"(ERAS) protocol regardless of the surgery approach. RESULTS During the study period, 210 patients matched the selection criteria. Of those, 158(75%) patients received opioids during the hospital stay or after discharge and 52(25%) patients never received opioids. SP-EPP surgical approach and shorter LOS were predictors of never receiving opioids (Odds Ratio [OR]=4.97, (95% CI 1.81-14.77, p=0.002 and OR=0.56, CI 95% 0.35-0.86, p=0.011, respectively). SP-EPP surgical approach was increasing the odds of remaining opioid free whether in-hospital or after discharge (OR= 11.97, 95% CI 4.8 - 32, p<0.0001 and OR=11.6, 95% CI 4.6-31, p<0.0001, respectively). Finally, a high BMI increased the odds of receiving opioid in hospital or after discharge (OR=0.89, 95% CI 0.82-0.96, p=0.003 and OR=0.89, 95% CI 0.82-0.96, p=0.002, respectively). CONCLUSIONS In this series, after robotic radical prostatectomy the use of a less invasive approach (SP-EPP), a shorter LOS and a lower BMI, were predictive of opioid-free status.