Achieving 1 day Length of Stay (LOS) for Kidney Surgery at a High-Volume District General Hospital
BAUS ePoster online library. Yao M. 06/23/21; 319036; p12-8
Disclosure(s): Nil to disclose
Mr. Mark Yao
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Abstract
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Introduction
Renal cancer surgery has a tendency towards longer inpatient length of stay (LOS) due to post-operative pain and the age of patients in comparison to, for example, radical prostatectomy. Our centre has recorded short length of stays compared to national outcomes.
Patients & Methods
All patients undergoing renal surgery with a single surgeon 2016-2021 (n=336) were assessed. This included nephrectomy (radical and benign), nephroureterectomy and partial nephrectomy. We aimed to ascertain predictors of shorter length of stay, with comparisons between multiple groups made by ANOVA with appropriate Bonferroni correction.
Results
The median LOS was 1.5 days (range 1-23), with a mode of 1 day LOS (40.5%, n=136). Predictors of shorter length of stay were: ASA grade (p=0.0005), with mean LOS for ASA-1 patients 1.6 days; and surgical approach (p=0.0009), with longer LOS for open procedures with a mean of 4.4 days. Males were more likely to be in the one-day LOS group in comparison to females (0.03). Age range was independent of LOS (p=0.07). 61% of all ASA-1 patients who had a laparoscopic or robotic operation were discharged the following day.
Conclusions
Short lengths of stay independent of age can be achieved with minimally invasive surgery at a high-volume centre. A one-day LOS can be the expectation for partial nephrectomy and nephroureterectomy with appropriate utilisation of enhanced recovery after surgery principles, especially in ASA-1 patients undergoing minimally invasive surgery.
Renal cancer surgery has a tendency towards longer inpatient length of stay (LOS) due to post-operative pain and the age of patients in comparison to, for example, radical prostatectomy. Our centre has recorded short length of stays compared to national outcomes.
Patients & Methods
All patients undergoing renal surgery with a single surgeon 2016-2021 (n=336) were assessed. This included nephrectomy (radical and benign), nephroureterectomy and partial nephrectomy. We aimed to ascertain predictors of shorter length of stay, with comparisons between multiple groups made by ANOVA with appropriate Bonferroni correction.
Results
The median LOS was 1.5 days (range 1-23), with a mode of 1 day LOS (40.5%, n=136). Predictors of shorter length of stay were: ASA grade (p=0.0005), with mean LOS for ASA-1 patients 1.6 days; and surgical approach (p=0.0009), with longer LOS for open procedures with a mean of 4.4 days. Males were more likely to be in the one-day LOS group in comparison to females (0.03). Age range was independent of LOS (p=0.07). 61% of all ASA-1 patients who had a laparoscopic or robotic operation were discharged the following day.
Conclusions
Short lengths of stay independent of age can be achieved with minimally invasive surgery at a high-volume centre. A one-day LOS can be the expectation for partial nephrectomy and nephroureterectomy with appropriate utilisation of enhanced recovery after surgery principles, especially in ASA-1 patients undergoing minimally invasive surgery.
Introduction
Renal cancer surgery has a tendency towards longer inpatient length of stay (LOS) due to post-operative pain and the age of patients in comparison to, for example, radical prostatectomy. Our centre has recorded short length of stays compared to national outcomes.
Patients & Methods
All patients undergoing renal surgery with a single surgeon 2016-2021 (n=336) were assessed. This included nephrectomy (radical and benign), nephroureterectomy and partial nephrectomy. We aimed to ascertain predictors of shorter length of stay, with comparisons between multiple groups made by ANOVA with appropriate Bonferroni correction.
Results
The median LOS was 1.5 days (range 1-23), with a mode of 1 day LOS (40.5%, n=136). Predictors of shorter length of stay were: ASA grade (p=0.0005), with mean LOS for ASA-1 patients 1.6 days; and surgical approach (p=0.0009), with longer LOS for open procedures with a mean of 4.4 days. Males were more likely to be in the one-day LOS group in comparison to females (0.03). Age range was independent of LOS (p=0.07). 61% of all ASA-1 patients who had a laparoscopic or robotic operation were discharged the following day.
Conclusions
Short lengths of stay independent of age can be achieved with minimally invasive surgery at a high-volume centre. A one-day LOS can be the expectation for partial nephrectomy and nephroureterectomy with appropriate utilisation of enhanced recovery after surgery principles, especially in ASA-1 patients undergoing minimally invasive surgery.
Renal cancer surgery has a tendency towards longer inpatient length of stay (LOS) due to post-operative pain and the age of patients in comparison to, for example, radical prostatectomy. Our centre has recorded short length of stays compared to national outcomes.
Patients & Methods
All patients undergoing renal surgery with a single surgeon 2016-2021 (n=336) were assessed. This included nephrectomy (radical and benign), nephroureterectomy and partial nephrectomy. We aimed to ascertain predictors of shorter length of stay, with comparisons between multiple groups made by ANOVA with appropriate Bonferroni correction.
Results
The median LOS was 1.5 days (range 1-23), with a mode of 1 day LOS (40.5%, n=136). Predictors of shorter length of stay were: ASA grade (p=0.0005), with mean LOS for ASA-1 patients 1.6 days; and surgical approach (p=0.0009), with longer LOS for open procedures with a mean of 4.4 days. Males were more likely to be in the one-day LOS group in comparison to females (0.03). Age range was independent of LOS (p=0.07). 61% of all ASA-1 patients who had a laparoscopic or robotic operation were discharged the following day.
Conclusions
Short lengths of stay independent of age can be achieved with minimally invasive surgery at a high-volume centre. A one-day LOS can be the expectation for partial nephrectomy and nephroureterectomy with appropriate utilisation of enhanced recovery after surgery principles, especially in ASA-1 patients undergoing minimally invasive surgery.
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