Factors associated with prolonged length of stay following robotic-assisted partial nephrectomy

Introduction: To prospectively analyze the association of clinical and operative variables on patient length of hospital stay (LOS) following robotic-assisted partial nephrectomy (RAPN) and develop an accurate clinical based scoring system to predict prolonged LOS following RAPN. Materials and methods: We analyzed 304 consecutive RAPNs performed by a single surgeon. Prolonged LOS was defined as greater than 3 days of hospitalization postoperatively. Preoperative clinical factors and operative variables were analyzed for association with LOS. After adjusting for multiple testing, p <= 0.004 was considered statistically significant. Results: LOS was 1 day in 17 (5.6%) patients, 2 days in 136 (44.7%) patients, 3 days in 89 (29.3%) patients, and more than 3 days in 62 (20.4%) patients. Lower preoperative hemoglobin (p = 0.004), total operative time (p < 0.001), estimated blood loss (EBL) (p < 0.001), intraoperative complications or conversion (p < 0.001), and renal mass size (p < 0.001) were associated with prolonged LOS. EBL and total operative time were most predictive of prolonged LOS and were used to create the BLOT (blood loss and operative time) predictive scoring system. Blot scores ranged from 0 to 5, to predict prolonged LOS. We observed prolonged LOS in 4.3%, 9.6%, 25.6%, 47.1%, 50.0%, and 100% of patients with scores of 0, 1, 2, 3, 4, and 5, respectively. Conclusions: Operative time and estimated blood loss are most predictive of prolonged LOS following RAPN. Using these variables, the BLOT score accurately predicts prolonged LOS following RAPN.