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Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis

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Same-Day Discharge After Robot-Assisted Partial Nephrectomy: Is It Worth It?

Andrew Wood¹, Dhaval Jivanji¹, Elie Kaplan-Marans¹

¹Department of Surgery, Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA.

Journal of Endourology

|December 4, 2022

Summary

Same-day discharge (SDD) after robot-assisted partial nephrectomy (RAPN) is safe and cost-effective, with similar complication rates to inpatient stays. This approach significantly reduces overall healthcare costs by approximately $3,000 per patient.

Keywords:

cost minimally invasive surgery outcomes partial nephrectomy same-day discharge

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Area of Science:

Urology
Minimally Invasive Surgery
Health Economics

Background:

Robot-assisted partial nephrectomy (RAPN) is a standard procedure for kidney tumors.
Traditionally performed as an inpatient procedure, same-day discharge (SDD) is being explored for RAPN.
Evaluating the safety and cost-effectiveness of SDD for RAPN is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

To assess the safety and cost-effectiveness of same-day discharge (SDD) following robot-assisted partial nephrectomy (RAPN).
To compare outcomes between SDD and traditional inpatient stays after RAPN.
To analyze the impact of an SDD protocol on patient recovery, readmission rates, and healthcare expenditure.

Main Methods:

Retrospective analysis of 192 patients undergoing RAPN between January 2015 and July 2021.
Comparison of outcomes before and after the implementation of an SDD protocol.
Assessment of postanesthesia care unit (PACU) time, length of stay, readmission rates, emergency department (ED) return rates, unplanned office visits (OVs), secondary procedures, and cost-efficacy analysis.

Main Results:

Implementation of an SDD protocol increased PACU discharge rates from 0% to 76%.
SDD demonstrated similar safety profiles to inpatient care, with no significant differences in readmission (1.4% vs 5.1%) or ED return rates (5.4% vs 9.3%).
SDD resulted in significantly lower total costs ($5,222 vs $8,425 per patient) despite increased PACU time and higher rates of unplanned office visits.

Conclusions:

Same-day discharge (SDD) for robot-assisted partial nephrectomy (RAPN) is a safe alternative to inpatient care, with comparable complication rates.
SDD leads to substantial cost savings of approximately $3,000 per patient.
Successful SDD implementation requires careful consideration of PACU capacity and enhanced post-discharge office support.