Preliminary Outcomes After Same Day Discharge Protocol for Robot-Assisted Partial Nephrectomy: A Single Centre Experience

Objective: To assess the feasibility and safety of same-day discharge (SDD) surgery after robot-assisted partial nephrectomy (RAPN) in patients with small renal tumors.

Methods: Observational, monocentric study conducted over a one-year period.

Inclusion Criteria: good performance status, Charlson score <5, cT1a renal mass and RENAL score <6.

Exclusion Criteria: coagulopathy or contraindication to outpatient surgery. RAPN was performed as the first case of the day. Anesthesia protocols allowed quick recovery and rapid hospital discharge. Patients were called systematically 1-day post-surgery to enquire about any early complications. Perioperative outcomes and complications were recorded according to Intraoperative adverse incident classification by the European Association of Urology and Clavien classifications 30- and 90-days post-surgery. Follow-up consultations were carried out with assessment of patient satisfaction. Primary outcomes were SDD failure, 30- and 90-day complications and readmission rate. Descriptive data were reported without statistical comparative analysis.

Results: Twenty patients were included (median age: 63 years [interquartile range: 57-64]). All patients were discharged home after a median surveillance time of 350 min (interquartile range: 270-420). One grade 1 intraoperative complication was reported. Two procedures were followed by an unplanned readmission due to early complications within the first 30 days (1 pain and anxiety [Clavien I], one active bleeding requiring embolization [Clavien IIIa]). The majority (85%) of patients were satisfied and would recommend day surgery. SDD failure rate was 10% at 90 days.

Conclusion: RAPN is safe as a SDD procedure without major perioperative morbidity for selected tumors and patients.