SAFE: Multi-institutional study of time to complications after robot-assisted partial nephrectomy, selection of a population eligible for outpatient management (UroCCR 90)

Introduction: The average hospital length of stay after robotic-assisted partial nephrectomy (RAPN) is 3 days, with a current trend towards outpatient cases, although no population has been identified. The main objective of the study was to analyze the time to onset of post-operative complications, identify risk factors for significant early complications in order to define a population eligible for outpatient case. Material and method: The study included 3342 patients with clinically localized renal tumors who underwent RAPN surgery between 2010 and 2021. The primary endpoint was the occurrence of significant complications (SC) (Clavien Dindo > 2 [CD]). A CS-free survival analysis was performed. A multivariate logistic regression model was fitted to predict the risk of early significant complications (ESC) after RAPN. Results: The rates of total complications and SC were 14.99% and 3.59% respectively. Median time to SC was significantly longer at 3 days [3.9-5.7] versus 2 days [2.4-3] for total complications (P = 0.012). The majority of complications occurred within the first 72 h, and the risk factors for early SC (< 72 h) (ESC) were clamping time (P = 0.04) and ASA > 2 score (P = 0.007). Analysis of survival without ESC showed a significant impact of clamping time (P = 0.043) on complication-free survival. Conclusion: Using standard preoperative variables, we were able to determine that the only factor influencing the occurrence of postoperative ESC was ASA score > 2 and thus define it as a primary eligibility criterion for an indication of outpatient RAPN subject to a clamp time of less than 20 mins. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license.