Laboratory Testing Following Robotic Assisted Laparoscopic Radical Prostatectomy Does Not Change Clinical Management
Ohad Kott, MD1, Osama Al-Alao, MD1, Jorge Pereira, MD2, Steven Reinert, PhD3, Christopher Tucci, RN1, Boris Gershman, MD1, Joseph Renzulli, Sr., MD4, Dragan Golijanin, MD1, Gyan Pareek, MD1
1Minimally Invasive Urology Institute, The Miriam Hospital; Department of Urology, The Warren Alpert Medical School of Brown University, Providence, RI, 2Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, FL, 3Lifespan, Providence, RI, 4Department of urology, Yale school of Medicine, New Haven, CT
BACKGROUND: Robotic assisted laparoscopic radical prostatectomy (RALP) has evolved into a safe and efficacious procedure with excellent outcomes. Routinely, laboratory tests are conducted following RALP. In this study, we evaluated the necessity of laboratory tests in patients undergoing RALP and any associated clinical value.
METHODS: Data was gathered retrospectively from records of patient between the ages of 40-80 that underwent RALP for prostate cancer in our institution between 3/29/2015 - 12/31/2017. Patients were included if they had RALP with or without lymph node dissection, preoperative laboratory testing performed within 30 days of surgery and again one day post- operatively. Patients were excluded if they had a concurrent procedure. The following laboratory values were reviewed: Hemoglobin, platelets, white blood cells, calcium, sodium, potassium, chloride and creatinine. Post-operative tests results were considered abnormal if they were outside our organizationís standardized normal range.
RESULTS: 156 patients met all above-mentioned criteria. 4 patients had abnormal laboratory values post-operatively (leukocytosis). After careful review of their medical records we found that all 4 patients were a-febrile, did not receive antibiotic treatment and were discharged the following day without any change in their clinical management. None of these patients had any post-operative complications, unplanned visits to ED or readmissions within 90 days.
CONCLUSIONS: In our retrospective observational study, we found no evidence of a clinical need to perform laboratory tests in uncomplicated patients undergoing RALP. Such unnecessary tests increase the chances of infection, increase costs and pose a burden on the healthcare system. There may still be a need to perform tests in patients that complicated intraoperatively or that have co-morbidities that predispose them for post-operative complications.
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