TITLE:
Open Partial Nephrectomy: One Night Length of Stay Is Safe and Cost Effective
AUTHORS:
Mohit Sirohi, Kyrollis Attalla, Harris M. Nagler, Erik T. Goluboff
KEYWORDS:
Cost Effective, Length of Stay, Open Partial Nephrectomy, Robotic Partial Nephrectomy
JOURNAL NAME:
Open Journal of Urology,
Vol.6 No.9,
September
14,
2016
ABSTRACT: Objective: To review our open partial
nephrectomy (OPN) experience and compare to known robotic partial nephrectomy
(RPN) data to determine whether length of stay (LOS) and morbidity are
significant drivers in the surgical approach employed for partial nephrectomy.
Methods: We reviewed our OPN experience during the last 3 years examining age,
tumor size, LOS, pathology, blood loss, complications, recurences, and deaths.
Results: Seventy-five patients underwent OPN during this period. Mean age was
59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350
cc. With a median follow-up of 18 months, there was one urinoma managed by
drain-age, one pseudo aneurysm that required embolization and one pulmonary
embolism that required anticoagulation. There were no readmissions, no tumor
recurences, and no deaths. Our major complication rate was 4% as compared to
other trials that re-ported major complication rates between 1% - 9% for RPN
and between 3% - 24% for OPN. In the first half of the experience (n = 37),
median LOS was 57 hours. Using a pathway encouraging early ambulation and
smaller incisions in the second half of the experience (n = 38), median LOS was
35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN
LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively
with one night hospital stay. This provides a more cost-effective approach to
partial nephrectomy with similar or better complication rates and calls into
question the main value drivers of RPN.