Same-Day Discharge After Robot-Assisted Partial Nephrectomy May Be Feasible in Some Patients

By Reuters Staff

May 02, 2022

NEW YORK (Reuters Health) - In selected patients undergoing robot-assisted partial nephrectomy (RAPN), same-day discharge is feasible, a small study suggests.

Dr. Daniel Benamran from the Sorbonne University and Hopital Pitie Salpetriere, Paris, France and colleagues found low readmission rates and a high success rate at 30 and 90 days in their study of 20 carefully selected patients who underwent RAPN as outpatients.

All 20 (55% male) had Eastern Cooperative Oncology Group performance status between 0-1 with no major comorbidities. Their American Society of Anaethesiologists classification was 2 or less, renal mass was less than 4 cm, and RENAL nephrometry score was <6, indicating low risk for postoperative complications. All patients were asked to get a blood test on postoperative day (POD) 1 and were called at home by a nurse by the next day.

Exclusion criteria included treatment with anticoagulants, complex tumors, and lack of help at home.

The median age of the 20 patients was 63(IQR 57-64); the median body mass index was 24 (IQR 23-26.5). Tumors were located on the right side in 8 patients (40%) and left in 12 (60%). Median tumor size by radiologic imaging was 24.5 mm (IQR 22-30 mm). In more than 90%, the tumor was at least 50% exophytic.

There were no conversions to an open approach. Median console operative time was 60 minutes (IQR 50-80). Median blood loss was 100 ml (IQR 50-125). No patient required transfusion. There was one (5%) intra-operative grade 1 event: a bleeding lumbar vein that was managed by a Hem-o-lock clip.

All patients were discharged home the same day with a median postoperative surveillance time of 350 min (IQR 270-420).

Two patients (10%) were later hospitalized. One was admitted on POD 1 for anxiety and pain control and was discharged within 24 hours. The other was admitted on POD 3 with a hematoma that was managed by emergency embolization; this patient was discharged home two days later.

There was no other complications. Reoperation and mortality rates were 0% at 30 and 90 days. Renal function was stable at 1 and 6 months in all patients.

Of the 20 partial nephrectomies, 18 (90%) were malignant. There were no positive margins and no recurrences at a median follow up of 12 months (IQR 6.4-13.2).

All patients were either happy (7; 35%) or very happy (13; 65%). Seventeen (85%) would recommend the outpatient pathway, but three (15%) would have preferred an overnight stay before discharge for comfort and to reduce anxiety.

The authors believe their study shows the feasibility of same-day RAPN for carefully selected patients. They caution, however, that this approach should be only undertaken in a large-volume center with extensive experience in robotic partial nephrectomy and enhanced recovery after surgery (ERAS) protocols. Safely sending patients home the same day, they add, "requires efficient organization, communication and exhaustive information for the patients, as well as optimization of perioperative steps."

SOURCE: Urology, online April 7, 2022.