Clinical pathway for 3-day stay after robot-assisted cystectomy

Typical lengths of stay after open cystectomy are 5 to 7 days, without dramatic differences reported for laparoscopic or robot-assisted cystectomy. We developed a clinical pathway for early discharge after robot-assisted cystectomy, attempting to take advantage of potentially decreased morbidity with this minimally invasive procedure and analyzed our initial outcomes.

The initial 30 consecutive patients undergoing robot-assisted cystectomy who were treated on a clinical pathway developed at our institution were reviewed. This included an extraction incision of ≤3 inches also used for urinary diversion, no intensive care unit stay, no nasogastric tube, and avoidance of intravenous narcotics. Ambulation is begun on postoperative day (POD) zero, with clear liquids uniformly on POD 1, then regular diet on passing flatus. Patients are discharged when tolerating diet, with a target of POD 3.

Mean age was 67 years (45-87 y), and mean operative time was 411 minutes. All ambulated by POD 1. Only 4 of 30 needed any intravenous narcotics. Twenty-one patients were discharged on POD 3 and 8 on POD 4 for an overall mean of 3.3 days, including 2 who were discharged on POD 2 and 1 on POD 7. One was seen in the emergency department on POD 6 for emesis, and one was readmitted on POD 7 for candidal infection. No others returned to the clinic or hospital within a week after discharge (POD 10).

Our clinical pathway after robot-assisted cystectomy allows shorter hospital stays than typical and is, to our knowledge, the shortest reported after cystectomy by any technique. Only two unplanned visits occurred during the first 10 days. Further experience will be necessary to confirm the initial success.