Early discharge after laparoscopic or robotic partial nephrectomy: care pathway evaluation

Abstract

OBJECTIVE: To determine the success of our clinical care pathway for laparoscopic (LPN) and robotic partial nephrectomy (RPN) and to examine factors predictive for success. PATIENTS AND METHODS: A retrospective review of our Institutional Review Board-approved prospectively maintained minimally invasive PN database yielded 263 consecutive minimally invasive PNs from 2003 to 2010. Patient, disease and surgery-related factors were collected. The primary endpoint was successful implementation of the clinical pathway with discharge on postoperative day (POD 1). Associated factors were modelled using univariate and multivariable logistic regression to determine factors predictive for success of the pathway. RESULTS: Overall, 157 (60%) of the patients had successful care pathway implementation with POD1 discharge, of which 46 (17%) were RPNs. The overall readmission rate was 5% (12/263) and similar for patients discharged on POD 1, 4.5% (7/157). Several patient-related, tumour-related, and surgical factors were associated with care pathway success. In a multiple logistic regression model, only surgery period (late cohort vs early cohort) was significant for successful pathway implementation (odds ratio 4.2; 95% confidence interval 2.1-8.4, P < 0.001). CONCLUSIONS: Early discharge care pathways can be successfully implemented for LPN or RPN with low readmission rates. Care pathway success improves with institutional experience.