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

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Minimally invasive partial nephrectomy (MIPN), including laparoscopic or robotic partial nephrectomy (RPN), is standard for T1 renal cell carcinoma (RCC).
• The expansion of outpatient surgery raises questions about its safety and feasibility for oncologic procedures like RPN.

Purpose of the Study:

• To assess the safety and trends of outpatient minimally invasive partial nephrectomy (MIPN), particularly robotic partial nephrectomy (RPN).
• To compare postoperative outcomes and identify predictors of adverse events in inpatient versus outpatient RPN.

Main Methods:

• Analysis of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data (2022-2023) for 8,927 adult RPN patients.
• Observation of outpatient MIPN trends (2019-2023) and propensity score matching to compare inpatient and outpatient RPN outcomes.
• Multivariate logistic regression to identify predictors of 30-day infectious complications, reoperations, and readmissions.

Main Results:

• Outpatient MIPN utilization increased from 20.8% in 2019 to 35.5% in 2023.
• After matching, outpatient RPN (3,185 cases) showed significantly lower rates of pneumonia, PE, MI, DVT, septic shock, transfusions, reoperation, and readmissions compared to inpatient RPN (3,180 cases).
• Inpatient setting was an independent predictor for infectious complications (OR: 1.31), reoperation (OR: 1.92), and readmission (OR: 1.23).

Conclusions:

• Outpatient MIPN is increasingly adopted, with RPN demonstrating comparable safety to inpatient procedures in selected patients.
• Findings support the safe expansion of outpatient RPN, highlighting the need for standardized protocols and equitable access.
• Further research on long-term outcomes and individualized risk stratification is warranted.