Non-modifiable factors predict discharge quality after robotic partial nephrectomy.
OBJECTIVE
To identify predictors of poor discharge quality after robotic partial nephrectomy (RPN) at a large academic center.


METHODS
We queried our institutional RPN database for consecutive patients treated between 2011 and 2015. The primary outcome was poor discharge quality, defined as length of stay >3 days and/or unplanned readmission. The association between patient, disease, and provider factors and overall discharge quality was assessed using univariate and multivariable analyses.


RESULTS
Of 791 cases, 219 (27.7 %) had poor discharge quality. On univariate analysis, factors associated with poor discharge quality were older age (p < .01), black race (p = .01), social insurance (p < .01), higher ASA score (p < .01), chronic kidney disease (p < .01), increased tumor size (p < .01), and higher tumor complexity (p = .01). Surgeon case volume did not predict discharge quality (p = .63). After adjustment for covariates on multivariable analysis, race (p = .01), ASA (p = .02), CKD (p < .01), tumor size (p = .02), and tumor complexity (p = .03) still predicted poor discharge quality. In particular, the odds of poor discharge quality were highest in the setting of CKD (OR 2.62, 95 % CI 1.72-4.01), black race (OR 2.17, 95 % CI 1.32-3.57), and higher ASA (OR 1.49, 95 % CI 1.07-2.08).


CONCLUSIONS
Non-modifiable patient and disease factors predict poor discharge quality after RPN. Risk adjustment for these factors will be important for determining future reimbursement for RPN providers.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA.
Matthew J
MJ
Maurice
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA.
Daniel
D
Ramirez
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA.|Department of Urology, Amasya University Medical School, Kilicaslan Street, #100, Amasya, Turkey.
Önder
Ö
Kara
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA.
Ryan J
RJ
Nelson
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA.
Peter A
PA
Caputo
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA.
Ercan
E
Malkoç
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA. kaoukj@ccf.org.
Jihad H
JH
Kaouk
D001741:Black or African American; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D010359:Patient Readmission; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D065287:Robotic Surgical Procedures; D047368:Tumor Burden; D014481:United States; D044465:White People
Length of stay; Nephrectomy; Patient discharge; Patient readmission; Robotic surgical procedures
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