title: Early discharge after laparoscopic or robotic partial nephrectomy: care pathway evaluation.
abstract: OBJECTIVE
  To determine the success of our clinical care pathway for laparoscopic (LPN) and robotic partial nephrectomy (RPN) and to examine factors predictive for success.
  
  
  METHODS
  A retrospective review of our Institutional Review Board-approved prospectively maintained minimally invasive PN database yielded 263 consecutive minimally invasive PNs from 2003 to 2010. Patient, disease and surgery-related factors were collected. The primary endpoint was successful implementation of the clinical pathway with discharge on postoperative day (POD 1). Associated factors were modelled using univariate and multivariable logistic regression to determine factors predictive for success of the pathway.
  
  
  RESULTS
  Overall, 157 (60%) of the patients had successful care pathway implementation with POD1 discharge, of which 46 (17%) were RPNs. The overall readmission rate was 5% (12/263) and similar for patients discharged on POD 1, 4.5% (7/157). Several patient-related, tumour-related, and surgical factors were associated with care pathway success. In a multiple logistic regression model, only surgery period (late cohort vs early cohort) was significant for successful pathway implementation (odds ratio 4.2; 95% confidence interval 2.1-8.4, P < 0.001).
  
  
  CONCLUSIONS
  Early discharge care pathways can be successfully implemented for LPN or RPN with low readmission rates. Care pathway success improves with institutional experience.
authors.affiliation: Department of Urology, DuPage Medical Group, Downers Grove, Chicago, IL, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Shay
authors.initials: S
authors.lastname: Golan
authors.forename: Aria
authors.initials: A
authors.lastname: Razmaria
authors.forename: Sandip
authors.initials: S
authors.lastname: Prasad
authors.forename: Scott
authors.initials: S
authors.lastname: Eggener
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalhav
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D010351:Patient Discharge; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome
keywords: care pathway; kidney cancer; minimally invasive; partial nephrectomy