Predictors of delayed hospital discharge after robot-assisted partial nephrectomy: the impact of single-port robotic surgery

Abstract

Purpose: To evaluate the predictors of delayed discharge for patients undergoing robot-assisted partial nephrectomy (RAPN) at our Institution since the introduction of the single port (SP) robotic system.

Methods: We performed a retrospective review of our prospectively maintained database of patients undergoing RAPN from September 2020 to August 2024. Patients were categorized by the postoperative day of their discharge: POD1 (single overnight stay) or POD > 1 (more than one night stay). Multivariable logistic regression analysis was used to test the probability of prolonged hospital stay (defined as more than one night stay) adjusting for age at surgery, surgical approach, Charlson comorbidity index, baseline hemoglobin, antiplatelet or anticoagulant medications, clinical tumor stage, and intraoperative blood transfusion.

Results: Overall, 255 patients were identified for the analysis. Patients discharged on POD1 were younger (p = 0.004), reported a lower Charlson Comorbidity Index (p = 0.002), higher preoperative hemoglobin levels (p = 0.005), and smaller tumor size (p < 0.001). Higher rates of discharge on POD1 were recorded for both multiport transperitoneal (59.5 vs. 40.5%, p = 0.02) and SP retroperitoneal (81.5 vs. 18.5%, p = 0.004). Clinical tumor stage (p = 0.02) and intraoperative blood transfusion (p = 0.05) emerged as independent risk factors for POD > 1. Baseline hemoglobin emerged as a protective factor (p = 0.05) as well as SP approach (p = 0.03).

Conclusion: SP-RAPN holds potential to shorten hospitalization without hampering surgical outcomes. By maximizing the adoption of a RP approach and minimizing surgical invasiveness, SP robotic surgery allows to significantly expand the pool of RAPN patients that can be discharged after a single overnight stay.

Keywords: Discharge; Multi-port; Robot-assisted partial nephrectomy; Single-port.