Dr. Wood’s advice on implementing same-day discharge following partial nephrectomy

In this video, Andrew Wood, MD, shares advice for implementing a same-day discharge protocol after robot-assisted partial nephrectomy. Wood was first author of the recent Journal of Endourology study, “Same-Day Discharge After Robot-Assisted Partial Nephrectomy: Is It Worth It?” Wood is a urologic oncology fellow at Glickman Urological & Kidney Institute at Cleveland Clinic in Cleveland, Ohio.

Transcription:

What advice do you have for urologists looking to implement this protocol?

First and foremost, just to reiterate, same-day discharge after partial nephrectomy can be done safely. It's something that is very stressful. The kidney is a very vascular organ, and we worry about bleeding in the postoperative period. But we have shown that this really does not typically happen in those first 24 hours. So it can be done safely, [and] it does save money for the health system. But it is important to consider certain factors about the patients before choosing who to attempt this type of protocol on—most importantly, the patient's ability to care for themselves, things like family involvement, proximity to the hospital. For instance, you don't want a patient that is going to fly back to another state immediately after the surgery. You have to think about the overall level of support and how easy it will be for them to return to care if something does happen. In addition, it's important to consider health-related and surgical-related factors before choosing who to attempt same-day discharge on—[factors] such as overall operative time, patient comorbidities, size and complexity of the tumor, and complexity of the intervention. These are important things to consider. And then finally, it's important to put in place a system to accommodate some of these additional burdens on other parts of the health care system: having a discussion with your [postanesthesia care unit] staff about the changes in the postoperative process that they can expect, or a discharge rather than an admission pathway, as well as talking to your office staff that there may be additional phone calls that are necessary in that 24- to 48-hour period, and maybe even move up the first postoperative office visits to earlier than they would have otherwise been to provide the ability to see these patients sooner, as well as to provide answers to some of the questions that patients inevitably will have in the early postoperative period.

What is the take-home message for the practicing urologist?

I would say based on our experience and a growing body of literature, same-day discharge after partial nephrectomy in properly selected patients is safe and cost effective for both patients and the health system. We believe that this is just the tip of the iceberg, that this practice is going to increase in the future as robotic surgical innovation continues with things like the single-port robot. Patient selection is extremely important, and communication with multidisciplinary, multi team member stakeholders is crucial.

This transcription was edited for clarity.