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Factors Influencing Length Of Hospital Stay After Robotic-Assisted Radical Prostatectomy
Jessica E. Kreshover, MD, MS, David Shi, BS, Haralampos Kamenidis, BA, MS, David S. Wang, MD, Richard K. Babayan, MD, Mark H. Katz, MD.
Boston University Medical Center, Boston, MA, USA.

Introduction: Literature has consistently shown improvement in length of hospital stay (LOS) for robotic-assisted radical prostatectomy (RARP) over the traditional open approach. It is common for patients to be discharged on post-operative day (POD) 1 after RARP. There are patients however, that require longer hospitalization. The purpose of this research was to identify patient, disease, and/or operative characteristics that may contribute to LOS beyond POD1 in patients who have undergone RARP.
Methods: Retrospective review of all RARP cases performed at a single institution by 3 attending surgeons (RKB, DSW, MHK) from January 1, 2009 through May 31, 2011. Pre-operative, intra-operative, and post-operative data were collected. Cases were divided into two cohorts based on LOS. Patients discharged on POD1 were compared to those discharged on ≥ POD 2. Patient characteristics examined included age, race, BMI, ASA score and type of insurance. Pre-operative (PSA, prostate volume, clinical stage, Gleason score) and operative (surgeon, case order, blood loss, operative time) characteristics were also examined for difference between the two cohorts.
Results: A total of 267 cases were performed over the almost 2.5 year time period. 183 (68.5%) of these patients were discharged on POD 1. Univariate analysis was conducted and there was no statistically significant difference in the two groups with respect to disease characteristics. The only patient characteristic that influenced LOS was type of insurance. The operative characteristics that were significantly different between the groups were attending surgeon, operative time, and blood loss (Table 1). Subsequent stepwise multivariate regression demonstrated operative time (p=0.004), estimated blood loss (p=0.030), and insurance status (p=0.046) remained significant predictors of LOS.
Table 1Patient CharacteristicsDisease CharacteristicsOperative Characteristics
AgeRaceBMIIns TypeASAPreop PSAPros VolGls SumcStgSurgeonCase OrderOR TimeEBL

Conclusions: In a contemporary cohort of patients undergoing RARP, almost 70% of patients were discharged home on POD1. No preoperative characteristics including age, BMI, ASA score, and PSA were found to be predictive of LOS other than type of insurance. Our data suggest that only increased operative time, increased blood loss, and insurance type were associated with LOS beyond 1 day. These data may aide in patient counseling regarding expectations for recovery after RARP.

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