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Same-day discharge for robotic-assisted pediatric urologic surgeries in rural settings: Are we ready to take the
Ahmed Abdelhalim1, Ahmad Dahman2, Samuel Luketich2
1Department of Urology, West Virginia University, Morgantown, WV, 26506, USA; Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt.
Introduction And Objective:
Nowadays, most pediatric urologic surgeries are performed as same-day discharge (SDD) surgeries. This study examines the safety and feasibility of SDD following reconstructive and ablative pediatric urologic robotic surgeries (PURS).
Materials & Methods:
A single institution database was reviewed for pediatric patients who underwent PURS and were discharged on the same day from the post-anesthesia care unit (PACU). Patients' charts were reviewed for demographics, operative reports, ER visits, unplanned hospital readmissions, reoperation, and phone calls to the urology team within 30 days of surgery.
Results:
Between 2019 and 2024, 56 children underwent PURS with SDD at a median age of 65.5 (7-214) months. Patients lived at a median distance of 55.6 (3.1-249) miles from the study institution. Pyeloplasty was the most common procedure, encompassing 23 (41.1 %) patients. Conversion to laparoscopy or laparotomy was not needed in any patient. All patients were discharged from the PACU after meeting the discharge criteria with a mean length of stay of 126.5 ± 44.2 min. Within 30 days of surgery, nine patients (16.1 %) had a total of 10 ER visits after a median of 17 (1-28) days for Clavien-Dindo I or II complications. The most common reasons for ER visits were obstructed foley catheter, urinary retention, and fever in two patients each. One patient was readmitted for postoperative fever 28 days after the index surgery. The urology team received 17 phone calls from 15 patients within 30 days, none resulted in ER visits or hospitalizations. Reoperation was not needed in any patient within 30 days.
Discussion:
The relatively low perioperative morbidity, the low risk of significant bleeding, urinary leakage and organ injury associated with pediatric urologic robotic procedures, and the good performance status of pediatric candidates for robotic surgeries represent opportunities for SDD surgeries. A growing body of literature demonstrates the safety and feasibility of outpatient robotic surgeries with relatively more complex and high-risk surgeries in adults such as robotic prostatectomy, nephrectomy, and adrenalectomy. A limited number of studies have explored this approach following robotic urologic surgeries in children. We demonstrate the safety and feasibility of SDD following PURS even in rural communities where longer travel distances, limited access to transportation, and paucity of pediatric specialists represent additional barriers to SDD.
Conclusion:
SDD is safe and feasible following most PURS with an acceptable ER return and low readmission rates.
