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29.08.2018 | Original Article | Ausgabe 5/2019

World Journal of Urology 5/2019

Next-day discharge after minimally invasive partial nephrectomy: an analysis of the US National Surgical Quality Improvement Program

Zeitschrift:
World Journal of Urology > Ausgabe 5/2019
Autoren:
Ian Berger, Leilei Xia, Colin Sperling, Raju Chelluri, Benjamin Taylor, Jose Pulido, Thomas J. Guzzo
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00345-018-2469-2) contains supplementary material, which is available to authorized users.

Abstract

Purpose

Clinical care pathways and new technologies have decreased the length of stay after many surgeries. However, doubt exists about the safety of shorter hospital stays. We sought to evaluate the feasibility of next-day discharge after minimally invasive partial nephrectomy in a national cohort of US patients and surgeons.

Methods

Using the National Surgical Quality Improvement Program database, we analyzed patients who underwent minimally invasive partial nephrectomy from 2012 to 2016. Patients were grouped into discharge on post-operative day 1, or discharge on days 2 and 3. Propensity score matching was used to balance patient characteristics and univariable analysis was used to determine the effect of next-day discharge on readmission, post-discharge complications, and major post-discharge complications.

Results

A total of 8153 patients were included in the analysis and 4430 were matched. The matched cohort was balanced on all patient and peri-operative characteristics. On univariable analysis, no increase in odds were observed in the next-day discharge group for readmission (odds ratio 0.8; 95% confidence interval 0.6–1.4; p = 0.2), post-discharge complications (odds ratio 1.0; 95% confidence interval 0.7–1.4; p = 0.9), or post-discharge major complications (odds ratio 0.9; 95% confidence interval 0.5–1.4; p = 0.6).

Conclusions

Next-day discharge in select patients after minimally invasive partial nephrectomy is effectively being utilized by a large, nationwide cohort of surgeons. This approach is feasible in certain patient populations though further research must determine selection criteria for safe next-day discharge.

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