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Same-day discharge following minimally invasive partial and radical nephrectomy: a National Surgical Quality
Krishna Teja Ravivarapu1, Evan Garden1, Chih Peng Chin1
1Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA.
Purpose:
Minimally invasive partial nephrectomy (MIPN) and radical nephrectomy (MIRN) have successfully resulted in shorter length of stay (LOS) for patients. Using a national cohort, we compared 30-day outcomes of SDD (LOS = 0) versus standard-length discharge (SLD, LOS = 1-3) for MIRN and MIPN.
Methods:
All patients who underwent MIPN (CPT 50,543) or MIRN (CPT 50,545) in the ACS-NSQIP database from 2012 to 2019 were reviewed. SDD and SLD groups were matched 1:1 by age, sex, race, body mass index, American Society of Anesthesiologists score, and medical comorbidities. We compared baseline characteristics, 30-day Clavien-Dindo (CD) complications, reoperations, and readmissions between SDD and SLD groups. Multivariable logistic regressions were used to evaluate predictors of adverse outcomes.
Results:
28,140 minimally invasive nephrectomy patients were included (SDD n = 237 [0.8%], SLD n = 27,903 [99.2%]). There were no significant differences in 30-day readmissions, CD I/II, CDIII, or CD IV complications before and after matching SDD and SLD groups. On multivariate regression analysis, SDD did not confer increased risk of 30-day complications or readmissions for both MIPN and MIRN.
Conclusion:
SDD after MIPN and MIRN did not confer increased risk of postoperative complications, reoperation, or readmission compared to SLD. Further research should explore optimal patient selection to ensure safe expansion of this initiative.
Insights
Same-day discharge (SDD) after minimally invasive partial nephrectomy (MIPN) and radical nephrectomy (MIRN) is safe. Patients undergoing SDD experienced no increased risk of complications, reoperation, or readmission compared to standard-length discharge (SLD).
Area of Science:
- Urology
- Surgical Outcomes
- Health Services Research
Background:
- Minimally invasive partial nephrectomy (MIPN) and minimally invasive radical nephrectomy (MIRN) are standard procedures.
- Shorter length of stay (LOS) is a goal in surgical care.
- Same-day discharge (SDD) is being explored as a strategy to reduce LOS.
Purpose of the Study:
- To compare 30-day outcomes for same-day discharge (SDD) versus standard-length discharge (SLD) after MIPN and MIRN.
- To evaluate the safety and efficacy of SDD in a national cohort.
Main Methods:
- A national cohort of 28,140 patients undergoing MIPN or MIRN from 2012-2019 was analyzed.
- Patients were divided into SDD (LOS=0) and SLD (LOS=1-3) groups.
- 1:1 matching was performed based on demographics and comorbidities, followed by comparison of 30-day complications, reoperations, and readmissions using multivariable logistic regression.
Main Results:
- No significant differences were found in 30-day readmissions or Clavien-Dindo complications (I-IV) between SDD and SLD groups post-matching.
- Multivariate analysis confirmed that SDD did not increase the risk of 30-day complications or readmissions for either MIPN or MIRN.
Conclusions:
- Same-day discharge following MIPN and MIRN is a safe option.
- SDD does not lead to increased postoperative complications, reoperations, or readmissions compared to standard-length discharge.
- Further research is needed to identify optimal patient selection criteria for expanding SDD initiatives.
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