Same-day discharge after holmium laser enucleation facilitated by medical support teams

A group of researchers conducted a study to investigate perceived barriers to successful same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) from the perspective of surgical and nursing staff members.

A 17-question survey was administered to intraoperative and postoperative surgical staff in June 2021 after a six-month period of implementing an SDD holmium laser enucleation of the prostate (HoLEP) pathway with same-day catheter removal. McNemar's and Stuart-Maxwell tests were performed for statistical analysis.

Results of the study are:

Surveys were completed by 30 respondents. The majority of respondents had less than 5 years of surgical experience (63%). Almost all respondents (96%) felt that holmium laser enucleation of the prostate (HoLEP) patients could be discharged safely on the day of surgery. Overall, 60% felt that holmium laser enucleation of the prostate (HoLEP) had a lower risk of postoperative bleeding compared to other transurethral surgeries. There was a significant decrease in the number of respondents that felt apprehensive when comparing initiation of SDD HoLEP pathway to 6-months post-implementation (43% vs 7%, p=0.003). The most common factors causing apprehension both pre-and post-implementation included: degree of hematuria (43% vs 40%, p=0.56), risk of failure of trial of void (40% vs 30%, p=0.26), and risk of readmission or unplanned emergency department (ED) visit (33% vs 30%, p=0.48). There was a significant decrease in the number of respondents who were apprehensive about lack of experience with SDD after HoLEP comparing pre-and post-implementation (20% vs 0%, p=0.01).

Thus, the researchers concluded that while staff report initial apprehension regarding implementation of an SDD HoLEP pathway, adequate support to intraoperative and postoperative teams helps build an experience that alleviates these concerns.

Reference:

Barriers to implementation of a same-day discharge pathway for Holmium Laser Enucleation of the Prostate by Jenny Guo, et al. published in the Urology.

https://www.goldjournal.net/article/S0090-4295(21)01184-5/fulltext