Commentary:
Amid the COVID-19 global pandemic, several institutions have developed and adopted same-day discharge (SDD) pathways to maintain proper patient flow, avoid treatment postponement, and mitigate hospital revenue loss from canceling surgeries [1]. The feasibility and safety of SDD Robotic-assisted laparoscopic radical prostatectomy (RALP) using multiport platforms has been corroborated by several studies [2]. Recently, Balasubramanian et al. reported on the safety and feasibility of SDD post Single port-RALP (SP-RALP). Of the 51 patients eligible for SDD after SP-RALP, 15 underwent SDD, and 36 opted for standard discharge process due to various reasons such as pain, fatigue, other medical reasons, and nonmedical reasons related to distance from hospital and being a second start surgery. [3] Encouragingly, the study demonstrated comparable outcomes in regard to complications, 90-day readmission and 90-day emergency room visits between the SDD and standard discharge process.
Future efforts should focus on optimizing the multifaceted aspects of SDD. This can be achieved by investing in the peri-operative educational material for the patient and caregiver, Outpatient surgery pre-admission tours, transportation planning and securing access to immediate telemedicine follow-up during the early postoperative period. Additionally, mobile applications may be helpful to monitor vital signs, encourage utilization of incentive spirometer and promote ambulation [4].
More subjective criteria to best select patients for SDD include 5-items modified frailty score to screen for comorbidities, assessing patient’s health literacy, availability of transportation, and the presence of a caregiver [5, 6].
Prior to even beginning an operation, early communication with the anesthesia team about the planned SDD is crucial to ensure selection of proper anesthetics agents associated with rapid recovery and less incidence of postoperative nausea and vomiting. Also, adoption of opioid-free pathways with preemptive use of NSAIDs and administering regional anesthesia such as Transversus Abdominis Plane (TAP) block have been found to decrease postoperative opioid requirement and postoperative nausea and vomiting [7]. Furthermore, the use of the Valveless-Trocar System for maintaining low pneumoperitoneum has been linked to lower postoperative pain and nausea episodes [8].
Finally, the discharge process could be optimized by assessing the readiness for discharge using a standardized assessment tool for the quality of the recovery and ensuring clear discharge instructions and the availability of educational materials to both the patient and the caregiver [9, 10].
It is clear that our practice patterns have been irrevocably changed during recent years. Adopting a multimodal approach to SDD provides a safe and effective pathway for care that benefits patients, physicians and healthcare systems alike.
Author contributions
MS contributed to project development and manuscript writing. RD contributed to manuscript writing. DL contributed to supervision and manuscript editing.
Data availability statement
There is no data related to this commentary.
Declarations
Conflict of interest
The author declares that they have no conflict of interest.
Research involving human participants and/or animals
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Footnotes
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Contributor Information
Mohammed Shahait, Email: mshahait@yahoo.com.
Rayan Dobbs, Email: ryanwdobbs@gmail.com.
David I. Lee, Email: dilee1@hs.uci.edu
References
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Data Availability Statement
There is no data related to this commentary.