MP39-18 SAME DAY DISCHARGE AFTER ROBOTIC PARTIAL NEPHRECTOMY: IS IT WORTH IT?

Abstract

You have accessJournal of UrologyCME1 May 2022MP39-18 SAME DAY DISCHARGE AFTER ROBOTIC PARTIAL NEPHRECTOMY: IS IT WORTH IT? Andrew Wood, Eitan Katlowitz, Elie Kaplan-Marans, Marc Lubin, Ervin Teper, David Silver, and Ariel Schulman Andrew WoodAndrew Wood More articles by this author , Eitan KatlowitzEitan Katlowitz More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Marc LubinMarc Lubin More articles by this author , Ervin TeperErvin Teper More articles by this author , David SilverDavid Silver More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002599.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot Assisted Partial Nephrectomy (RAPN) has traditionally been performed as an inpatient procedure. However, recent pilot studies have suggested that same day discharge (SDD) for RAPN is feasible. Safety and cost effectiveness for SDD for RAPN have not been well demonstrated. We hypothesize that SDD for RAPN has a favorable safety profile, and is associated with significant cost savings. METHODS: We performed a retrospective cohort analysis of patients undergoing RAPN at our academic medical center between January 2016 and July 2021. Review was conducted before and after implementation of a SDD protocol which began on July 1, 2018. We assessed PACU time, length of stay (LOS), 30 day readmission rate, 30 day return to ED rate, unplanned office visits, as well as transfusion rate and need for secondary procedure. A cost efficacy model was generated using publicly available Medicare cost data to estimate the difference in overall hospital expenditure between SDD and traditional inpatient RAPN. RESULTS: 197 patients underwent RAPN during the study period. After protocol implementation, the percentage of patients discharged from the post anesthesia care unit (PACU) increased from 2.0% to 74.2% (p: <0.001). Patients admitted to the floor stayed an average of 1.35 days, resulting in an expenditure of $3519.45 per patient. Compared to inpatient RAPN, SDD was associated with increased PACU time (6:23 vs 3:52, p <0.001), resulting in an additional expenditure of $2228.76 per patient. SDD patients were less likely to be readmitted within 30 days and more likely to return to the ED without being readmitted (NS). SDD patients were more likely to return for unplanned office visits (17.6% vs. 7.3%, p=0.027). Overall, the total post-OR cost for SDD was significantly lower than that of inpatient RAPN ($5,940.08 per patient vs. $7395.21, p: <0.001). There was no difference in need for transfusion or secondary procedure between SDD and inpatient RAPN. CONCLUSIONS: Despite a shorter post-op monitoring period, SDD appears safe, with equivalent rates of readmission, return to ED, and secondary procedures. SDD for RAPN saves approximately $1500 per patient. In implementing a SDD protocol, clinicians should be cognizant of increased demands on PACU infrastructure, and be willing to provide additional post-op support in the office setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e672 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Wood More articles by this author Eitan Katlowitz More articles by this author Elie Kaplan-Marans More articles by this author Marc Lubin More articles by this author Ervin Teper More articles by this author David Silver More articles by this author Ariel Schulman More articles by this author Expand All Advertisement PDF DownloadLoading ...