A single overnight stay is possible for most patients undergoing robotic partial nephrectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Minimally invasive surgery (MIS) aims to reduce hospitalization, but actual lengths of stay after robotic partial nephrectomy (RPN) often mirror open surgery.
• A standardized clinical pathway was implemented to facilitate same-day discharge after RPN.

Purpose of the Study:

• To evaluate the feasibility and safety of discharging patients on postoperative day 1 (POD 1) after RPN of any complexity.
• To assess the impact of a POD 1 discharge protocol on patient outcomes and readmission rates.

Main Methods:

• A single-surgeon series of 160 RPNs was reviewed following the implementation of a clinical pathway.
• The pathway included early ambulation, diet, avoidance of IV narcotics and drains, and catheter removal on POD 1 for discharge.
• Discharge criteria were applied uniformly, irrespective of RPN complexity, tumor characteristics, or need for renal artery clamping.

Main Results:

• 145 out of 150 patients (97%) were discharged on POD 1, with a mean length of stay of 1.1 days.
• Patients undergoing complex RPNs, including those with hilar tumors or solitary kidneys, were successfully discharged on POD 1.
• Only 4 patients (2.7%) required readmission within 30 days, indicating a low complication rate.

Conclusions:

• Same-day discharge (POD 1) is a safe and feasible strategy for the majority of patients undergoing robotic partial nephrectomy.
• The established clinical pathway effectively facilitates early discharge without compromising patient safety or increasing readmission rates.
• Extended hospital stays may not be necessary for patients meeting early discharge criteria after RPN.