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Partial nephrectomy should be classified as an inpatient procedure: Results from a statewide quality improvement

Kyle Johnson1, Brian R Lane2, Alon Z Weizer1

  • 1Michigan Medicine, Ann Arbor, MI.

Urologic Oncology
|January 24, 2021
PubMed
Abstract

Insights

Minimally invasive partial nephrectomy (MIPN) and radical nephrectomy (MIRN) for kidney tumors have similar lengths of stay. Most patients require at least two days in the hospital, suggesting MIPN should be an inpatient procedure.

Area of Science:

  • Urology
  • Nephrology
  • Surgical Outcomes Research

Background:

  • Minimally invasive partial nephrectomy (MIPN) and minimally invasive radical nephrectomy (MIRN) are common treatments for localized renal masses (cT1RM).
  • The Centers for Medicare & Medicaid Services currently classifies MIPN as an outpatient procedure and MIRN as an inpatient procedure.
  • Despite technical complexities and higher complication rates, MIPN's outpatient classification is debated.

Purpose of the Study:

  • To compare the length of stay (LOS) and readmission rates for MIPN versus MIRN in patients with cT1RM.
  • To evaluate the appropriateness of classifying MIPN as an outpatient procedure based on actual hospital LOS.

Main Methods:

  • A retrospective analysis of 807 patients undergoing MIPN or MIRN for cT1RM across 12 Michigan urology practices (May 2017-February 2020).
  • Data collected included clinical, radiographic, pathologic, surgical, and short-term follow-up information.
  • Length of stay was analyzed, with a focus on comparing outcomes for MIPN and MIRN.

Main Results:

  • The median LOS for both MIPN (n=531) and MIRN (n=276) was 2 days.
  • No significant difference was found in LOS between MIPN and MIRN for procedures qualifying as outpatient (≤1 day LOS).
  • Less than one-third of patients (32% for MIPN, 29% for MIRN) had a LOS of ≤1 day.

Conclusions:

  • The actual hospital LOS for MIPN is comparable to MIRN, with most patients requiring at least a 2-day stay.
  • Current classification of MIPN as an outpatient procedure by CMS may not reflect clinical reality.
  • It is recommended that MIPN be classified as an inpatient procedure, similar to MIRN, given the typical hospital stay.
Keywords:
Outpatient surgeryPartial nephrectomyRenal cell carcinomaSmall renal mass

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