Early discharge after laparoscopic or robotic partial nephrectomy: care pathway evaluation.

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Minimally invasive partial nephrectomy (PN) includes laparoscopic (LPN) and robotic (RPN) approaches.
• Clinical care pathways aim to standardize and improve patient management and outcomes.
• Early discharge protocols are increasingly explored for surgical procedures.

Purpose of the Study:

• To evaluate the success of a clinical care pathway for LPN and RPN.
• To identify factors predicting the successful implementation of this pathway.
• To assess the impact of the pathway on patient discharge and readmission rates.

Main Methods:

• Retrospective review of 263 minimally invasive PNs (2003-2010).
• Data collected on patient, disease, and surgery-related factors.
• Primary endpoint: successful pathway implementation with postoperative day 1 (POD 1) discharge.
• Univariate and multivariable logistic regression used to identify predictive factors.

Main Results:

• 60% of patients (157/263) achieved successful pathway implementation with POD 1 discharge.
• 46 of these successful cases (17%) were RPNs.
• Overall readmission rate was 5%, with 4.5% for POD 1 discharges.
• Only the surgery period (late vs. early cohort) significantly predicted pathway success (OR 4.2, P < 0.001).

Conclusions:

• Early discharge care pathways are feasible and effective for LPN and RPN.
• These pathways are associated with low readmission rates.
• Successful implementation of care pathways is enhanced by increasing institutional experience.