To identify preoperative characteristics in patients with renal masses that influence operative time during robot-assisted partial nephrectomy (RAPN) and evaluate the relationship between operative time and length of stay, complication rates, and overall outcome.
We queried our institutional database to identify a cohort of patients who underwent RAPN by two experienced robotic surgeons between 2012 and 2019. A multivariable regression model was developed to analyze operative time, length of stay, and any grade complication within 30 days postoperatively using bootstrap resampling technique.
A total of 392 patients were included. On multivariable analyses, prior abdominal surgery (p=0.001) was associated with 22 minute increase in operating room time; as well as adhesive perirenal fat (22 minutes, p=0.001). For each one unit increase in nephrometry score, there was a four minute increase in operating room time (p=0.028), and for each one cm increase in tumor size, there was an associated 12 minute increase in operating room time (p<0.001). For each one year increase in age, there was an associated 0.024 day increase in length of stay [(odds ratio (0.013-0.035)]; additionally, for every one cm increase in tumor size there was a 0.18 day associated increase in length of stay [OR (0.070-0.28)]. Each one hour increase in operating room time was associated with a 0.25 day increased length of stay [OR (0.092, 0.41)]. Only tumor size was found to be associated with any grade complication.
Patients with a history of abdominal surgery, larger complex tumors, and significant Gerota's fat undergoing robotic partial nephrectomy should anticipate longer operative times. Older patients with larger tumors and longer operative times can anticipate a longer length of stay. Tumor size appears to be the common determinant of all three outcomes: operative time, length of stay, and any grade Clavien complication.
Journal of endourology. 2021 Sep 24 [Epub ahead of print]
Naveen Krishnan, Jason Zappia, Adam Calaway, Ramzy T Nagle, Chandru P Sundaram, Ronald S Boris
Indiana University School of Medicine, 12250, Urology, 550 University Blvd, Indianapolis, Indiana, United States, 46202; ., Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States; ., Case Western Reserve University Hospital, 24575, Urology, Cleveland, Ohio, United States; ., Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States; ., Indiana University School of Medicine, Urology, 535 N Barnhill Dr, Suite 420, Indianapolis, Indiana, United States, 46202; ., Indiana University School of Medicine, Urology, Indiana Cancer Pavilion, 535 N Barnhill Dr. Suite 150, Indianapolis, Indiana, United States, 46202; .