Same-Day Discharge After Robot-Assisted Partial Nephrectomy: Is It Worth It?

被引:9
作者
Wood, Andrew [1 ]
Jivanji, Dhaval [1 ]
Kaplan-Marans, Elie [1 ]
Katlowitz, Eitan [1 ]
Lubin, Marc [1 ]
Teper, Ervin [1 ]
Silver, David [1 ]
Schulman, Ariel [1 ]
机构
[1] Maimonides Hosp, Dept Surg, Div Urol, Brooklyn, NY 11219 USA
关键词
same-day discharge; partial nephrectomy; outcomes; cost; minimally invasive surgery; ENHANCED RECOVERY; SURGERY; OUTCOMES;
D O I
10.1089/end.2022.0510
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction and Objective: Robot-assisted partial nephrectomy (RAPN) has traditionally been performed as an inpatient procedure; however, recent studies have suggested the feasibility of same-day discharge (SDD) after RAPN. We aimed to evaluate the safety and cost-effectiveness of SDD for RAPN.Methods: A retrospective analysis was conducted on patients undergoing RAPN between January 2015 and July 2021. Comparison before and after the implementation of an SDD protocol was assessed through differences in postanesthesia care unit (PACU) time, length of stay, 30-day readmission rate, 30-day return to emergency department (ED) rates, unplanned office visits (OVs), and need for secondary procedures. A cost-efficacy model was generated to estimate the difference in expenditure between SDD and inpatient RAPN.Results: In total, 192 patients underwent RAPN with 74 being SDD and 118 being admitted postoperatively. After SDD protocol implementation, the percentage of patients discharged from the PACU increased from 0% to 76%. The safety profile of SDD was similar to the inpatient group, with no differences in readmission rates (1.4% vs 5.1%, p = 0.18) or return to ED (5.4% vs 9.3%, p = 0.33). Compared with inpatient RAPN, SDD was associated with increased time in PACU (375 vs 251 minutes, p < 0.001), resulting in an additional expenditure of $1,622 per patient. SDD patients were more likely to return for one or more unplanned OVs (17.6% vs 6.8%, p = 0.02). Overall, the total cost of SDD was significantly lower than inpatient RAPN ($5,222 per patient vs $8,425, p < 0.001).Conclusion: Despite a shorter postoperative monitoring period, SDD appears safe, with equivalent readmission rates, return to ED, and secondary procedures. SDD for RAPN saves similar to$3,000 per patient. In implementing an SDD protocol, clinicians should be cognizant of increased demands on PACU infrastructure and be willing to provide additional support in the office setting.
引用
收藏
页码:297 / 303
页数:7
相关论文
共 32 条
[1]  
Akkamahadevi P, 2016, Indian J Anaesth, V60, P58, DOI 10.4103/0019-5049.174812
[2]  
[Anonymous], 1999, MED INP ADM 1999 202
[3]   Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc) [J].
Assmus, Mark A. ;
Large, Tim ;
Lee, Matthew S. ;
Agarwal, Deepak K. ;
Rivera, Marcelino E. ;
Krambeck, Amy E. .
JOURNAL OF ENDOUROLOGY, 2021, 35 (09) :1386-1392
[4]   Laparoscopic Nephrectomy as Outpatient Surgery [J].
Azawi, Nessn H. ;
Christensen, Tom ;
Dahl, Claus ;
Lund, Lars .
JOURNAL OF UROLOGY, 2016, 195 (06) :1671-1675
[5]   Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs [J].
Azhar, Raed A. ;
Bochner, Bernard ;
Catto, James ;
Goh, Alvin C. ;
Kelly, John ;
Patel, Hiten D. ;
Pruthi, Raj S. ;
Thalmann, George N. ;
Desai, Mihir .
EUROPEAN UROLOGY, 2016, 70 (01) :176-187
[6]  
Bailey MK., 2019, HCUP STAT BRIEF 24
[7]   Preliminary Outcomes After Same Day Discharge Protocol for Robot-Assisted Partial Nephrectomy: A Single Centre Experience [J].
Benamran, Daniel ;
Grobet-Jeandin, Elisabeth ;
Msika, Jeremy ;
Vaessen, Christophe ;
Parra, Jerome ;
Seisen, Thomas ;
Roupret, Morgan .
UROLOGY, 2022, 164 :145-150
[8]   Day-case robotic-assisted partial nephrectomy: feasibility and preliminary results of a prospective evaluation (UroCCR-25 AMBU-REIN study) [J].
Bernhard, Jean-Christophe ;
Robert, Gregoire ;
Ricard, Solene ;
Michiels, Clement ;
Capon, Gregoire ;
de Hautecloque, Astrid Boulenger ;
Bensadoun, Henri ;
Gay, Josephine ;
Rogier, Julien ;
Tauzin-Fin, Patrick ;
Gross-Goupil, Marine ;
Benard, Antoine ;
Nouette, Karine ;
Roullet, Stephanie ;
Ferriere, Jean-Marie .
WORLD JOURNAL OF UROLOGY, 2022, 40 (06) :1351-1357
[9]   Management of patients undergoing same-day discharge primary total hip and knee arthroplasty [J].
Bodrogi, Andrew ;
Dervin, Geoffrey F. ;
Beaule, Paul E. .
CANADIAN MEDICAL ASSOCIATION JOURNAL, 2020, 192 (02) :E34-E39
[10]   Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I [J].
Campbell, Steven C. ;
Clark, Peter E. ;
Chang, Sam S. ;
Karam, Jose A. ;
Souter, Lesley ;
Uzzo, Robert G. .
JOURNAL OF UROLOGY, 2021, 206 (02) :199-208