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Same-day discharge following minimally invasive partial and radical nephrectomy: a National Surgical Quality Improvement Program (NSQIP) analysis

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Abstract

Purpose

Minimally invasive partial nephrectomy (MIPN) and radical nephrectomy (MIRN) have successfully resulted in shorter length of stay (LOS) for patients. Using a national cohort, we compared 30-day outcomes of SDD (LOS = 0) versus standard-length discharge (SLD, LOS = 1–3) for MIRN and MIPN.

Methods

All patients who underwent MIPN (CPT 50,543) or MIRN (CPT 50,545) in the ACS-NSQIP database from 2012 to 2019 were reviewed. SDD and SLD groups were matched 1:1 by age, sex, race, body mass index, American Society of Anesthesiologists score, and medical comorbidities. We compared baseline characteristics, 30-day Clavien–Dindo (CD) complications, reoperations, and readmissions between SDD and SLD groups. Multivariable logistic regressions were used to evaluate predictors of adverse outcomes.

Results

28,140 minimally invasive nephrectomy patients were included (SDD n = 237 [0.8%], SLD n = 27,903 [99.2%]). There were no significant differences in 30-day readmissions, CD I/II, CDIII, or CD IV complications before and after matching SDD and SLD groups. On multivariate regression analysis, SDD did not confer increased risk of 30-day complications or readmissions for both MIPN and MIRN.

Conclusion

SDD after MIPN and MIRN did not confer increased risk of postoperative complications, reoperation, or readmission compared to SLD. Further research should explore optimal patient selection to ensure safe expansion of this initiative.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA

    Krishna Teja Ravivarapu, Evan Garden, Chih Peng Chin, Micah Levy, Osama Al-Alao, Joseph Sewell-Araya, Reza Mehrazin & Michael Palese

  2. Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA

    Alexander Small

Authors
  1. Krishna Teja Ravivarapu
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  2. Evan Garden
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  3. Chih Peng Chin
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  4. Micah Levy
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  5. Osama Al-Alao
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  6. Joseph Sewell-Araya
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  7. Alexander Small
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  8. Reza Mehrazin
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  9. Michael Palese
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Contributions

Each person listed as an author has fulfilled the criteria for authorship established by the International Committee of Medical Journal Editors. Project development (KTR, EG, O Al-A, JS-A, A S, R, M), data analysis (KT, EG, CP C, ML), manuscript writing (KT R, E G, CP C), manuscript editing (A S, R M, M P).

Corresponding author

Correspondence to Michael Palese.

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Ethics approval

This study was deemed exempt by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai.

Conflict of interest

The authors did not receive any funds, grants, or other support from any organization for the submitted work. The authors have no competing interests to declare. This study was deemed exempt from both informed patient consent and Institutional Review Board approval as it involved analysis of aggregate, de-identified data.

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Ravivarapu, K.T., Garden, E., Chin, C.P. et al. Same-day discharge following minimally invasive partial and radical nephrectomy: a National Surgical Quality Improvement Program (NSQIP) analysis. World J Urol 40, 2473–2479 (2022). https://doi.org/10.1007/s00345-022-04105-0

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  • DOI: https://doi.org/10.1007/s00345-022-04105-0

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