SAFE: Multi-institutional study of time to complications after robot-assisted partial nephrectomy, selection of a population eligible for outpatient management (UroCCR 90).

The average hospital length of stay after robotic-assisted partial nephrectomy (RAPN) is 3 days, with a current trend towards outpatient cases, although no population has been identified. The main objective of the study was to analyze the time to onset of post-operative complications, identify risk factors for significant early complications in order to define a population eligible for outpatient case. The study included 3342 patients with clinically localized renal tumors who underwent RAPN surgery between 2010 and 2021. The primary endpoint was the occurrence of significant complications (SC) (Clavien Dindo>2 (CD)). A CS-free survival analysis was performed. A multivariate logistic regression model was fitted to predict the risk of early significant complications (ESC) after RAPN. The rates of total complications and SC were 14.99% and 3.59% respectively. Median time to SC was significantly longer at 3 days [3.9 - 5.7] versus 2 days [2.4 - 3] for total complications (p=0.012). The majority of complications occurred within the first 72 hours, and the risk factors for early SC (<72h ) (ESC) were clamping time (p= 0.04) and ASA>2 score (p= 0.007). Analysis of survival without ESC showed a significant impact of clamping time (p=0.043) on complication-free survival. Using standard preoperative variables, we were able to determine that the only factor influencing the occurrence of postoperative ESC was ASA score >2 and thus define it as a primary eligibility criterion for an indication of outpatient RAPN subject to a clamp time of less than 20 minutes.

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