Discussion
cancer, postoperative pain, RP, including reduced blood loss
CANCER, PERIOPERATIVE COMPLICATION, COMPLICATION
MIRP has several advantages over traditional procedures, including reduced blood loss and transfusion rates, decreased postoperative pain, and a shorter duration of hospitalization in more recent cases [Historically, the duration of hospitalization following open RP has decreased with increasing surgical experience over the last 100 years, as noted by Klein et al. [Several high-volume surgical centers have described their initial experience regarding the safety and viability of outpatient robot-assisted laparoscopic radical prostatectomy (RARP), reporting similar complication and outcome rates [Berger et al. [These data reinforce the notion that patient selection and motivation are important factors influencing same-day discharge from the hospital following surgery. Similarly, the support network provided at hospital discharge is also important success in the immediate postoperative period. The use of an intermediate care hospital, established in a municipality, reduced length of stay without increasing readmissions, admissions, mortality, activities of daily living, primary health care utilization or total care days [Khalil et al. [Despite promising evidence, relevant studies have included well-selected patient populations with limited comorbidities, an ideal BMI, and adequate social support. Most patients included in the study of outpatient RARP by Khalil et al. [In addition to the feasibility and safety of early discharge of this selected population, we found that satisfaction of the patients was high, independently on discharge time. This result corroborates several reports [As surgeons have become more experienced with RARP, some of the initially restrictive criteria used for patient selection, such as BMI or the need for lymph node dissection, have been expanded in more recent series [This study had several strengths when compared with previous investigations. To the best of our knowledge, this is the first prospective, randomized study of early discharge after RP conducted at one of the largest cancer hospitals in Latin America. Our findings expand the body of knowledge regarding safety and patient satisfaction in cases of same-day discharge after surgery and provide insight into factors that may predict success following early discharge.Despite these strengths, our study also had some limitations. Although the calculation of the number of patients was performed under very well delimited parameters, the sample size is not extensive. It is well known that patient satisfaction surveys can suggest positive results even when the results are poor. To limit the influence of such bias, we utilized a validated satisfaction instrument (SATIS-BR), which was administered shortly after discharge by a third researcher blinded to the patient groups. Furthermore, given that procedures were performed by surgical experts at high-volume centers, no patients in our study experienced perioperative complications, which naturally increased the likelihood of high satisfaction scores regardless of hospitalization time. Additionally, some questions possibly were not well-understood by the patients, which could have biased some results. For example, one patient of the same-day discharge group answered that felt that the length of his stay was long. Lastly, while the study was conducted at a public hospital, participants exhibited significant differences in socioeconomic status.