A Single Overnight Stay Is Possible for Most Patients Undergoing Robotic Partial Nephrectomy

OBJECTIVE To evaluate establishment of overnight stay only as sufficient after robotic partial nephrectomy (RPN). METHODS Stated benefits of minimally invasive surgery include reduced hospitalization, but published hospital stays after laparoscopic or robotic partial nephrectomy are not significantly less than with open surgery. We developed a clinical pathway targeting discharge on postoperative day (POD) 1 after RPN of any complexity. We reviewed all RPNs by a single surgeon since instituting our clinical pathway, including ambulation and diet the night of surgery, avoidance of intravenous narcotics and drains, and catheter removal on POD 1 before discharge. Targeted discharge was not modified regardless of RPN complexity. RESULTS A total of 150 consecutive patients underwent 160 RPNs with 35 hilar tumors and 26 with segmental, and 33 with no artery clamping. Three had solitary kidneys, and 8 underwent multiple (range, 2-4) RPNs. Mean patient age was 57 years (range, 22-89 years), and body mass index was 32 kg/m(2) (range, 18-54 kg/m(2)). Mean tumor size was 3.6 cm (range, 1.0-11.0; median, 3.2 cm), and the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score was 8 (range, 4-12; median, 8). Mean warm ischemia time was 12.1 minutes (range, 0-30.0 minutes). Mean preoperative and discharge creatinine were 0.9 mg/dL (range, 0.43-2.79 mg/dL) and 1.13 mg/dL (range, 0.56-2.93 mg/dL). All patients ambulated on POD 0. One patient required one dose of intravenous narcotic. Mean length of stay was 1.1 days, with 145 (97%) discharged on POD 1, of which only 4 (2.7%) were readmitted within 30 days. CONCLUSION Discharge on POD 1 is feasible in most RPN patients regardless of complexity. Readmission rate was low, indicating that longer admissions may not prevent complications when patients meeting discharge criteria go home on POD 1. UROLOGY 81: 301-307, 2013. (C) 2013 Elsevier Inc.