Minerva Urologica e Nefrologica 2020 Dec 01

DOI: 10.23736/S0393-2249.20.04038-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Predictive factors for opioid-free management after robotic radical prostatectomy: the value of the SP® Robotic Platform

Guilherme SAWCZYN ¹, Louis LENFANT ^{1, 2}, Alireza AMINSHARIFI ^{1, 3}, Soodong KIM ¹, Jihad KAOUK ¹ ✉

¹ Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; ² Sorbonne University, GRC n°5, Predictive Onco‑urology, AP‑HP, Hôpital Pitié‑Salpêtrière, Urology Department, Paris, France; ³ Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran

BACKGROUND: The objective was to evaluate perioperative factors associated with opioid-free management after robotic radical prostatectomy in a single institution.
METHODS: From January 2019 to January 2020, data from patients who underwent robotic radical prostatectomy was retrospectively entered in a pre-approved IRB database. Data were analyzed according to the postoperative opioid administration in hospital and/or after discharge. Robotic radical prostatectomy was performed using either the standard multi-port Da Vinci Si robotic platform with a transperitoneal approach(MP-RALP) or the novel DaVinci SP® robotic platform with an extraperitoneal approach(SP-EPP). Patients undergoing minimally invasive surgery were included in the "enhanced recovery after surgery"(ERAS) protocol regardless of the surgery approach.
RESULTS: During the study period, 210 patients matched the selection criteria. Of those, 158(75%) patients received opioids during the hospital stay or after discharge and 52(25%) patients never received opioids. SP-EPP surgical approach and shorter LOS were predictors of never receiving opioids (Odds Ratio [OR]=4.97, (95% CI 1.81-14.77, p=0.002 and OR=0.56, CI 95% 0.35-0.86, p=0.011, respectively). SP-EPP surgical approach was increasing the odds of remaining opioid free whether in-hospital or after discharge (OR= 11.97, 95% CI 4.8 - 32, p<0.0001 and OR=11.6, 95% CI 4.6-31, p<0.0001, respectively). Finally, a high BMI increased the odds of receiving opioid in hospital or after discharge (OR=0.89, 95% CI 0.82-0.96, p=0.003 and OR=0.89, 95% CI 0.82-0.96, p=0.002, respectively).
CONCLUSIONS: In this series, after robotic radical prostatectomy the use of a less invasive approach (SP-EPP), a shorter LOS and a lower BMI, were predictive of opioid-free status.

KEY WORDS: Opioids; Narcotics; Single port surgery; Robotic surgery; Robotic; Prostatectomy