Enhanced Recovery after Robot-Assisted Partial Nephrectomy for Cancer: Is it Better for Patients to Have a Quick Discharge?

Abstract

<b><i>Objectives:</i></b> The aim of the study was to assess the efficacy and safety of an enhanced recovery program (ERP) after robot-assisted partial nephrectomy (RAPN) for cancer. <b><i>Methods:</i></b> It was a monocentric, retrospective, comparative study. An ERP after RAPN was introduced at our institution in 2015 and proposed to all consecutive patients admitted for RAPN. The control group for this study was composed of patients managed immediately before the introduction of the ERP. We collected information on patient characteristics, tumor sizes, ischemia times, biology, hospital length of stays, postoperative (≤30 days) complications, and readmission rates. Group comparisons were made using the Pearson χ² test for qualitative data and the Student <i>t</i> test for quantitative data. <b><i>Results:</i></b> Between 2015 and 2017, 112 patients were included in the ERP group. Fifty patients were included in the control group. Ninety patients in the ERP group (80.4%) were discharged at or before postoperative day (POD) 2 versus 10 patients (20%) in the control group (<i>p</i> &#x3c; 0.001). There was no significant difference between the ERP and control groups for the urinary retention rate (respectively 3.6 vs. 2%; <i>p</i> = 0.593). Resumption of normal bowel function was significantly shorter in the ERP group (94.6% at POD1 vs. 69.6% in the control group, <i>p</i> &#x3c; 0.001). There were no significant differences for postoperative complications (15.2% in the ERP group vs. 20% in the control group, <i>p</i> = 0.447) or readmissions within 30 days (8.04 vs. 0.2%, <i>p</i> = 0.140). <b><i>Conclusions:</i></b> ERP after RAPN seems to reduce postoperative length of stay without increasing postoperative complications or readmissions.