Impact of robotic surgery on sick leave and return to work in patients undergoing radical prostatectomy: An evidence-based analysis

Introduction: We analyzed the current evidence regarding the impact of robot-assisted radical prostatectomy vs open radical prostatectomy on the duration of sick leave for patients undergoing prostate cancer surgery. Methods: A systematic review of the literature was performed up to March 2019 using PubMedÒ and Web of Science. Study selection followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) Statement. Baseline and surgical outcomes were assessed for comparison between the robot-assisted radical prostatectomy and open radical prostatectomy groups. Review Manager 5.3 software was used to perform statistical analysis. Results: Five comparative studies were identified as eligible for analysis. Patients who underwent robot-assisted radical prostatectomy were younger (WMD -0.82; 95% CI -1.24, -0.39; p=0.0002) and had a higher educational level (OR 0.54; 95% CI 0.45, 0.65; p <0.0001). Surgical outcomes assessment revealed a positive trend in favor of robot-assisted radical prostatectomy regarding estimated blood loss (WMD -595 ml; 95% CI -1,179.79, -12.81; p=0.05). The robot-assisted radical prostatectomy group presented a shorter length of stay (WMD -1.62 days; 95% CI -2.45, -0.79; p <0.001) and sick leave (WMD -10.03 days; 95% CI -16.87, -3.20; p=0.004). Conclusions: Notwithstanding the low quality of the current literature, available evidence suggests that robot-assisted radical prostatectomy allows shorter sick leave and quicker return to work than open radical prostatectomy. This should be regarded as an indirect cost benefit of the procedure and considered in cost analysis studies comparing robotic surgery to open surgery. Further research in this area is warranted.