Same-day discharge after robotic partial nephrectomy appears safe

In this video, Andrew Wood, MD, discusses the background and notable findings from the recent Journal of Endourology study, “Same-Day Discharge After Robot-Assisted Partial Nephrectomy: Is It Worth It?” Wood is a urologic oncology fellow at Glickman Urological & Kidney Institute at Cleveland Clinic in Cleveland, Ohio.

Please describe the background for this study.

Maimonides Medical Center has a very early and rich history of innovation in robotic surgery. We had one of the very first DaVinci robots on the East Coast in clinical practice in the early 2000s. We're routinely looking to push the envelope to make surgery safer and more effective. We were early adopters of an expedited discharge protocol after robotic prostate and kidney surgery. Initially, we utilized a narcotic-free, 23-hour expedited discharge pathway, discharging patients the morning after their partial nephrectomy surgery. Eventually, we noticed that none of these patients were really having any overnight events that required intervention, and so we slowly progressed to same-day discharge in appropriately selected patients. At the same time as we were undergoing this transition, the COVID-19 pandemic came along and emphasized the importance of minimizing the exposure of patients to the health care system, which really accelerated our interest in continuing to pursue same-day discharge.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

First and foremost is that same-day discharge appears to be safe. There were no failure-to-rescue events within 24 to 48 hours after discharge outside of the hospital. And very rarely do patients need to come back in for readmission or even come to the ER. That's the most important finding. Additionally, the protocol does reduce costs for the patients in the health care system overall. This is particularly important in this day and age as people become more and more aware of the importance of health care cost. [We also found] that there are additional burdens on certain parts of the health care team. Multi-team-member engagement is critical. Patients need to be counseled ahead of time that they may need to return to the office more often. Things like increased PACU time was something that we didn't necessarily envision seeing; patients had 50% to 60% more time in the PACU for same-day discharge protocol, because they needed to be prepared to go home and were not just going up to the regular floor. That was somewhat surprising to us, but it's an important finding, because anyone who's looking to institute a protocol of this type needs to be prepared for those sort of multi-team-member effects.

This transcript was edited for clarity.