Rapid Discharge after Transoral Robotic Surgery

Abstract

Objectives:

1) Analyze the Johns Hopkins’ experience of rapid discharge after transoral robotic surgery (TORS). 2) Describe those factors that allow for rapid discharge and those which require longer postoperative hospitalization following TORS.

Methods:

All transoral robotic surgery (TORS) cases performed by the senior author were retrospectively reviewed. Length of hospitalization (LOH) was the primary outcome measurement. LOH was analyzed in regards to disease process, stage, performance of other concurrent procedures (ie neck dissection, percutaneous endoscopic gastrostomy [PEG] placement), age, gender, co-morbidities, and intra-operative complications. Secondary outcome measures included postoperative complications, tracheotomy and PEG dependency rates, and need for re-admission to hospital.

Results:

Seventy-eight cases from October 2009 through February 2013 were included for analysis. The average LOH was 1.2 days. LOH was found to be significantly longer in patients with obstructive sleep apnea undergoing lingual tonsillectomy than in oncologic patients. All patients were discharged home on a per oral diet. No patients had a tracheotomy or PEG tube at 6 months postoperatively. The postoperative complication rate was 5% and was independent of the LOH.

Conclusions:

TORS has seen tremendous growth in the last few years for the treatment of oropharyngeal carcinoma and obstructive sleep apnea (OSA). To date, there have been no formal recommendations regarding postoperative management of these patients. We demonstrate that rapid discharge after undergoing TORS is safe, well-tolerated, has a low complication rate, and does not result in hospital re-admission. However, patients with OSA required longer hospitalizations. This further supports the cost-effectiveness of TORS over other treatment paradigms for oropharyngeal cancer.