Re: Outpatient Robot-Assisted Radical Prostatectomy: Are Patients Ready for Same-Day Discharge? by Dobbs et al.

Dear Editor:

The recent article by Dobbs et al. examined the patient perspective on same-day discharge (SDD) after robot-assisted laparoscopic prostatectomy (RALP). ¹ In a survey administered in the postoperative period, 68.4% of patients reported that they would not have been ready for discharge from the postanesthesia care unit, citing concerns, including pain control and catheter care. The authors suggest that this reflects a discrepancy between patient preferences and the emerging practice of RALP SDD. However, there are two important considerations in interpreting these findings.

First, more structured perioperative care pathways will improve the success of SDD. Preoperative teaching and delivery of medications and supplies decrease patient uncertainties about postsurgical care and nonurgent communication. Ploussard et al. recently showed the efficacy of a structured enhanced recovery after surgery protocol and prehabilitation program in enhancing SDD after RALP. ² The pathway will be further boosted by continued advances in home-monitoring and virtual visits that will increasingly be used in the postoperative setting. Remote monitoring technologies provide objective data that can trigger an in-person evaluation, and video visits after surgery can be used to directly address any patient concerns.

Second, SDD reduces the risk of adverse events from medical care and the risk of nosocomial infection. Death from medical error among hospital patients is 251,454 a year, estimated to be the third largest cause of death in the United States. ³ Hospitalization also increases the risk of nosocomial infections from contact with other patients, hospital staff, or the facility itself. ⁴ This has become acutely important in the current coronavirus 2019 (COVID-19) outbreak. Thus, the comfort of knowing that our postoperative patients are closely monitored overnight at the hospital is not without risks.

We recognize that not all patients are appropriate for SDD. The patient must be motivated, have sufficient home support, and the ability to return to the hospital quickly for an emergency. Nonetheless, increased adoption of structured pathways, continued development of virtual technologies, and rethinking of health care practices as a result of the COVID-19 era likely will significantly contribute to the increasing role of SDD after RALP.