Predicting length of stay after robotic partial nephrectomy

Abstract

Introduction To investigate factors predictive of length of stay (LOS) after robotic partial nephrectomy (RPN) in an effort to identify patients suitable for RPN with overnight stay at outpatient surgical facilities. Materials and Methods Retrospective chart review of patients who underwent RPN at Memorial Sloan Kettering Cancer Center from January 2007 to July 2012 was conducted. Univariate and multivariate analyses were performed to identify the main predictors of LOS. The discrimination of the multivariate model was measured using the area under the curve (AUC); 10-fold cross-validation was performed to correct for over-fit. Results One hundred and eighty-six patients were included in the analysis; 84 (45%) had LOS of ≤ 1 day (median LOS, 2 day; interquartile range, 1–2). On univariate analysis, preoperative variables associated with LOS >1 included larger tumors (P < 0.0001), lower estimated glomerular filtration rate (P = 0.003), older age (P = 0.006), female gender (P = 0.035), and higher comorbidity score (P = 0.015); operative variables associated with LOS > 1 day included greater estimated blood loss (P < 0.0001) and longer operative (P < 0.0001) and ischemia (P < 0.0001) times. The AUC of the preoperative model was 0.61 (95% CI, 0.52–0.69) after 10-fold cross-validation. Conclusions LOS after RPN is influenced by age, gender, medical co-morbidities, and tumor size. However, when analyzed retrospectively, these factors had limited ability to predict LOS after RPN with sufficient accuracy to develop a prediction tool.

Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy

“…Length of stay is an increasingly scrutinized surrogate for cost efficient care. Similar to our findings, prior studies have demonstrated the relationship between operative time and length of stay for partial nephrectomy 31,32,33 . The fastest operative time patients were hospitalized one less day on average than the slowest operative time patients (2.2 vs 3.3 days).…”

Application of Contrast-Enhanced Ultrasonography (CEUS) in the Assessment of Kidney Wound Recovery After Nephron-Sparing Surgery

“…Several retrospective studies showed larger tumor size was related to LOS>1 day and prolonged LOS after RANSS. 32,33 Correspondingly, R score of two points (tumor size>4cm) was associated with longer LOE in our study. The prediction formula could provide a reference for the evaluation of LOE and relatively safe time of discharge before surgery, especially helpful for hospitals without the condition of CEUS examination in an underdeveloped region.…”

Robot‐assisted partial nephrectomy: continued refinement of outcomes beyond the initial learning curve

“…Specifically, we found that over time, more RAPNs are being performed in patients with larger tumours, hypertension, diabetes and previous abdominal surgery. In RAPN, these factors are reported to lead to worse peri‐operative outcomes, with increasing tumour size leading to greater EBL, longer WIT, longer LOS and less trifecta achievement , major open abdominal surgery leading to more EBL and hypertension leading to worse immediate postoperative kidney function . Despite increased prevalence of these adverse factors over time, we show that from consecutive cases 50 to 300 among four surgeons, trifecta achievement continuously increased as WIT, EBL, peri‐operative blood transfusions and LOS continuously decrease beyond the surgeon's initial RAPN experience.…”