Rising Trends and Safety of Outpatient Robotic Partial Nephrectomy: A Propensity-Matched National Analysis

Introduction Minimally invasive partial nephrectomy (MIPN), laparoscopic or robotic partial nephrectomy (RPN), is the preferred treatment for T1 renal cell carcinoma (RCC). As outpatient surgery expands across urology, its safety and feasibility in oncologic procedures, like MIPN and especially RPN, remain underexplored. Methods Using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data (2022-2023), we identified 8,927 adult patients who underwent RPN. Trends in outpatient MIPN, both laparoscopic and robotic approaches, were observed from 2019 to 2023. Patients who underwent RPN were then categorized by inpatient or outpatient setting. Propensity score matching was applied to balance demographic and clinical variables. Postoperative complications and readmissions were compared, and multivariate logistic regression identified predictors of adverse outcomes such as 30-day infectious complications, reoperations, and readmissions. Results Outpatient MIPN increased from 20.8% (n = 884) in 2019 to 35.5% (n = 1827) in 2023. After matching, 3,180 inpatient and 3,185 outpatient cases of RPN were analyzed. With the current patient selection criteria, outpatient RPN was associated with significantly lower rates of pneumonia, pulmonary embolism, myocardial infarction, deep vein thrombosis, septic shock, blood transfusions, reoperation, and readmissions. Logistic regression identified inpatient setting as an independent predictor of infectious complications (odds ratio (OR): 1.31), reoperation (OR: 1.92), and readmission (OR: 1.23). While outpatient surgery was associated with lower complication rates, this likely reflects the selection of healthier patients for ambulatory care rather than an intrinsic advantage of the outpatient setting. Conclusion Outpatient MIPN is increasingly utilized, and RPN demonstrates non-inferior safety compared to inpatient procedures in appropriately selected patients. However, disparities in access and limitations in surgical and oncologic data warrant further investigation. These findings support the safe expansion of outpatient RPN, emphasizing the need for standardized protocols, equitable access, and future research into long-term outcomes and individualized risk stratification.