Patient outcomes in the acute recovery phase following robotic-assisted prostate surgery: A prospective study

https://doi.org/10.1016/j.ijnurstu.2007.07.010Get rights and content

Abstract

Background: Robotic-assisted minimally invasive urologic surgery was developed to minimise surgical trauma resulting in quicker recovery. It has many potential benefits for patients with localised prostate cancer over traditional surgical techniques without taking a risk with the oncological result.

Objectives: To report the specific surgical outcomes for the first Australian cohort of patients with localised prostate cancer that had undergone robotic-assisted radical prostatectomy (RARP) surgery. The outcomes represent the acute (in-hospital) recovery phase and include pain, length of stay (LOS), urinary catheter management and wound management.

Methods: Prospective descriptive survey of 214 consecutive patients admitted to a large metropolitan private hospital in Melbourne, Australia between December 2003 and June 2005. Patients had undergone RARP surgery for localised prostate cancer. Data were collected from the medical records and through interview at the time of discharge. Descriptive statistics were used to describe the frequency and proportion of outcomes. Patient characteristics were tabulated using cross tabulation frequency distribution and measures of central tendency.

Results: The findings from this study are highly encouraging when compared to outcomes associated with traditional surgical techniques. Transurethral catheter duration (median 7 days (IQ range 2)) and LOS (median 3 days (IQ range 2)) were considerably reduced. While operation time (median 3.30 h (IQ range 1.07)) was marginally reduced we would expect a further reduction as the surgical team becomes more skilled.

Conclusion: The findings from this study contribute to building a comprehensive picture of patient outcomes in the acute (in-hospital) recovery phase for a cohort of Australian patients who have undergone RARP surgery for localised prostate cancer. As such, these findings will provide valuable information with which to plan care for patients’ who undergo robotic-assisted surgery.

Section snippets

What is already known about the topic?

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    There will be an increase in the surgical application of minimally invasive technologies.

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    The reported patient benefits of robotic technology include reduced length of patient stay, reduced postoperative pain, reduced bladder catheterisation time and improved functional ability.

What this paper adds

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    Reports on specific patient outcomes following robotic-assisted prostate surgery in the acute (in-hospital) recovery phase to:

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      commence building a comprehensive picture of the trajectory of recovery, and

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      allow hospitals to adapt their care and management protocols for this new patient group.

Literature review

Prostate cancer, a disease that most often occurs in the older male (Crowe and Costello, 2003) is the second most common cause of cancer related deaths in men and is a major health concern worldwide (Humphreys et al., 2004). It is the most common form of cancer among men over 55 years of age (Jemal et al., 2002). In Australia, prostate cancer is the most commonly diagnosed cancer in males and is the leading site of new cancer in Victoria in 2003. In 2003, prostate cancer was diagnosed in 3441

Method

Prospective descriptive survey of the acute transition of recovery (in-hospital stay) of patients who have undergone RARP surgery for localised prostate cancer, admitted to a large metropolitan private hospital in Melbourne, Australia between December 2003 and June 2005. This 17-month timeframe reflects the introduction of robotic surgery for this patient group at this hospital. Descriptive statistics were used to describe the frequency and proportion of outcomes. Patient characteristics were

Demographic characteristics

The age range of patients admitted for RARP surgery was 46–73 years, mean age of 60.8 years (SD=6.0). Table 1 provides a breakdown of the patients’ age groups showing that 46.7% (n=100) were in the 51–60 year age group and 44.9% (n=96) were in the 61–70 year age group. The mean body mass index (BMI) of patients was 27.03 (SD=3.09).

A total of five surgeons conducted the surgery; however, two surgeons (surgeon A and surgeon B) conducted the majority (91%, n=195) of the procedures. Just over half

Discussion

The findings reported in this study related to this Australian cohort make an important contribution to our growing understanding of the recovery of patients following robotic-assisted MIV surgery.

Apart from referral to particular surgeons by the patients’ general practitioners it appears that some patients actively seek to have robotic-assisted surgery. This assertion is based on first, the number of men who did not live in the State of Victoria meaning that they travelled some distance and

Conclusion

The findings from this study report the patient outcomes in the acute recovery phase of an Australian cohort of patients who underwent RARP surgery for localised cancer. We have been able to commence building a comprehensive picture of the trajectory of recovery in acute care to inform practice.

As more patients undergo robotic-assisted surgery worldwide these findings will provide nurses, who are not experienced in caring for this patient group, with valuable information to plan in-hospital

Acknowledgement

The authors wish to thank Mr Justin Peters, MBBS, FRACS for his assistance with patient recruitment.

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