The Effectiveness of a Criteria-Led Discharge Initiative on the Length of Stay of Patients Who Underwent a Robotic-Assisted Laparoscopic Prostatectomy

ObjectivesTo determine the impact of a criteria-led discharge initiative (CLD) on the hospital length of stay of patients undergoing a robotic-assisted laparoscopic prostatectomy (RALP). MethodsThis is a cohort study of prospectively collected data completed at a major tertiary hospital from December 2017 to August 2020. The CLD initiative consists of 4 criteria: clinical haemodynamic stability (heart rate 100mmHg), a drain output of less than 50 mL, flatulence or bowel movement, and the ability to tolerate an oral diet. The primary outcome was hospital length of stay for patients before and after the introduction of CLD. ResultsOne hundred men undergoing RALP before the implementation of the CLD initiative were compared to 118 men undergoing RALP following the implementation of CLD. The patients had similar baseline demographic features. There was a significant difference found in hospital LOS with the pre-CLD group LOS (mean = 1.8 days, SE = 0.12) being longer than the LOS in the post-CLD group (mean = 1.4 days, SE = 0.09, P = 0.015). There were no significant between-group differences in the proportion of patients discharged on the first postoperative day and the 30-day readmission rate. ConclusionWithin our study population, we have demonstrated that the introduction of CLD was associated with reduced hospital LOS with no increase in adverse events. These findings support the need for the development of CLD in other conditions

A systematic review and meta-analysis of pelvic drain insertion after robot-assisted radical prostatectomy

Purpose To perform a systematic review and meta-analysis and to assess the clinical benefit of prophylactic pelvic drain placement following Robotic Assisted Laparoscopic Prostatectomy (RALP) with pelvic lymph node dissection (PLND) in patients with localized prostate cancer. Methods An electronic search of databases including Scopus, Medline and EMbase was conducted for articles that considered post-operative outcomes with pelvic drain placement (PD) and without pelvic drain placement (ND) after RALP. The primary outcome was rate of symptomatic lymphocele (requiring intervention) and secondary outcomes were complications as described by the Clavien-Dindo classification system. Quality assessment was performed using the Modified Cochrane Risk of Bias Tool for Quality Assessment. Results Six relevant articles, comprising 1,783 patients (PD = 1,253; ND = 530) were included. Use of PD conferred no difference in symptomatic lymphocoele rate (Risk difference 0.01; 95% CI -0.007 - 0.027), with an overall incidence of 2.2% (95% CI 0.013 - 0.032). No difference in low-grade (I - II; risk difference 0.035, 95% CI -0.065 - 0.148) or high-grade (III - V; risk difference -0.003, 95% CI -0.05 - 0.044) complications was observed between PD and ND groups. Low-grade (I-II) complications were 11.8% (95% CI 0 - 0.42) and 7.3% (95% CI 0 - 0.26), with similar rates of high-grade (III - V) complications, being 4.1% (95% CI 0.008 - 0.084) and 4.3% (95% CI 0.007 - 0.067) for PD and ND groups, respectively. Conclusion Pelvic drain insertion after RALP with ePLND did not confer significant benefits in prevention of symptomatic lymphocoele or post-operative complications. Based on these results, pelvic drain insertion may be safely omitted in uncomplicated cases following consideration of clinical factors

Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis

Purpose To compare the efficacy and time-to-discharge of two methods of trial of void (TOV): bladder infusion versus standard catheter removal.Methods Electronic searches for randomized controlled trials (RCTs) comparing bladder infusion versus standard catheter removal were performed using multiple electronic databases from dates of inception to June 2020. Participants underwent TOV after acute urinary retention or postoperatively after intraoperative indwelling catheter (IDC) placement. Quality assessment and meta-analyses were performed, with odds ratio and mean time difference used as the outcome measures.Results Eight studies, comprising 977 patients, were included in the final analysis. Pooled meta-analysis demonstrated that successful TOV was significantly higher in the bladder infusion group compared to standard TOV (OR 2.41, 95% CI 1.53-3.8, p =0.0005), without significant heterogeneity (I-2 =19%). The bladder infusion group had a significantly shorter time-to-decision in comparison to standard TOV (weighted mean difference (WMD)-148.96 min, 95% CI -242.29, - 55.63, p= 0.002) and shorter time-to-discharge (WMD - 89.68 min, 95% CI - 160.55, - 18.88, p = 0.01). There was no significant difference in complication rates between the two groups.Conclusion The bladder infusion technique of TOV may be associated with a significantly increased likelihood of successful TOV and reduced time to discharge compared to standard TOV practices

A prospective, matched comparison of ultra-low and standard-dose computed tomography for assessment of renal colic : Ultra-low vs standard-dose CT for renal colic

To determine the diagnostic accuracy of ultra-low-dose computed tomography (ULDCT) compared with standard-dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses).A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single-blinded review of the image sets was performed independently by three board-certified radiologists.Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02\ua0(0.16)\ua0mSv] than SDCT [mean (SD) 4.97\ua0(2.02)\ua0mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi o