Login to Access Video or Poster Abstract: MP96-12
Sources of Funding: None

Introduction

Minimally-invasive surgery is known to reduce postoperative length of stay (LOS) for many procedures, but published LOS after robotic partial nephrectomy (RPN) remain similar to what is achieved with contemporary open PN (2-3 days).  With increasing experience, some surgeons have transitioned to overnight stay after RPN, postulating that RPN is not so materially different from robotic prostatectomy, where routinely, LOS is overnight.  Critics suggest that RPN has risks and complications inherent to nephron-sparing surgery that mandate longer LOS. We investigated whether RPN surgeons who instituted a routine overnight stay protocol had more complications than those who did not.

Methods

We reviewed a multi-institutional database of 1,868 patients who underwent RPN by 6 surgeons from 2006-2016. Exclusions included 117 patients for stage >cT1b, multiple tumors, metastatic disease, or incomplete complication data. During the selected study period of 9/13-9/16, three surgeons used routine discharge on postoperative day (POD) #1, defined as >80%, while the others discharged patients without a protocol targeting POD#1.  A total of 655 patients met inclusion criteria during the 3-year period, including 455 with a POD#1 protocol surgeon and 210 patients without.  Complication rates were compared between groups using Chi-squared tests of independence.

Results

Among surgeons using a POD#1 protocol, 410 of 455 patients (90.2%) were discharged on POD#1 with 97.6%, 82.1% and 80.0% of patients discharged on POD#1 by each of the 3 surgeons.  Mean LOS overall was 1.13d with mean LOS for the others being 2.02d (p<.001) and 91.1% of patients discharged by POD#3.  Patients of POD#1 protocol surgeons had higher Charlson comorbidity score (4 vs. 2, p=.033) and were less likely to have a hilar tumor (15.9% vs. 23.1%, p=.03). There were no differences in age (p=.10), BMI (p=.164), tumor size (p=.502), or Nephrometry score (p=.974).  Between the POD#1 protocol group and the others, there were no significant differences in overall complications (9.5% vs. 8.6%, p=.715), major complications (2.0% vs. 3.8%, p=.164), medical complications (5.9% vs. 2.8%, p=.089), surgical complications (4.0% vs. 5.7%, p=.310), or complications by Clavien grade (p=.130).

Conclusions

Use of a protocol targeting discharge on POD#1 after RPN did not increase complications.  Surgeons performing RPN should assess whether such a practice is implementable among their patients to take advantage of the minimally-invasive nature of the operation and reduce LOS.

Funding

None