Login to Access Video or Poster Abstract: MP96-05
Sources of Funding: None

Introduction

Robot-assisted radical prostatectomy (RARP) has become the main surgical treatment for localized prostate cancer in the United States. Little is reported about the association between pre-discharge complications and post-discharge outcomes following RARP. The objective of this study was to explore the pre-discharge predictors of readmissions and post-discharge complications in RARP.

Methods

The National Surgery Quality Improvement Program (NSQIP) database was used to identify prostate cancer patients who underwent elective RARP from 2012 to 2014. Additional exclusion criteria were utilized to control heterogeneity. Multivariable logistic regression was performed to assess potential pre-discharge predictors of readmissions and post-discharge complications within 30 days of RARP.

Results

A total of 9,975 patients were included. The readmission rate in the cohort was 3.3% (n = 332), and 4.4% (n = 441) had at least 1 complication. Figure 1 shows the causes of readmissions and distributions of 30-days complications. Multivariable logistic regression showed that increased operative time (OT) (OR = 1.002, 95%CI = 1.001-1.003, P = 0.007), increased length of stay (LOS) (OR = 1.35, 95%CI = 1.23-1.48, P < 0.001), and a pre-discharge complication (OR = 2.24, 95%CI = 1.33-3.76, P = 0.002) were associated with readmission. Increased OT (OR = 1.002, 95%CI = 1.001-1.004, P = 0.003) and increased LOS (OR = 1.16, 95%CI = 1.02-1.30, P = 0.019) were associated with post-discharge complications. Logistic regression in patients without pre-discharge complications (n = 9,804) confirmed that increased OT (OR = 1.002, 95%CI = 1.000-1.003, P = 0.014) and increased LOS (OR = 1.34, 95%CI = 1.20-1.48, P < 0.001) were associated with readmissions. The results also confirmed that increased OT (OR = 1.002, 95%CI = 1.001-1.004, P = 0.003) and increased LOS (OR = 1.18, 95%CI = 1.04-1.34, P = 0.010) were associated with post-discharge complications.

Conclusions

Pre-discharge complications, OT, and LOS, appear to be associated with post-discharge morbidity outcomes in RARP. Identifying modifiable risk factors for complications and readmissions as well as developing post-operative surgical pathways is a high priority in delivering quality care. Further prospective studies are needed to validate our findings.

Funding

None