ORIGINAL ARTICLE   

Minerva Urology and Nephrology 2021 October;73(5):591-9

DOI: 10.23736/S2724-6051.20.04038-2

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 Unit of Predictive Onco-urology, Department of Urology, GRC N. 5, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; ³ Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran

BACKGROUND: The aim of this study 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 preapproved 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 (Intuitive Surgical, Inc., Sunnyvale, CA, USA) 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: Analgesics, opioids; Narcotics; Surgical procedures, operative; Robotic surgical procedures; Robotics; Prostatectomy