Presentation Authors: Ashley Shumate*, Isabella Galler, Colleen Ball, Kaitlynn Custer, David Thiel, Jacksonville, FL
Introduction: To prospectively evaluate outcomes and complications of robotic-assisted partial nephrectomy (RAPN) following elimination of post-operative surgical drains.
Methods: 360 consecutive robotic partial nephrectomies (RAPNs) performed by a single surgeon were analyzed from a prospectively-maintained database. Routine intraoperative placement of surgical drains was stopped at case 260. The subsequent 100 patients without drains and preceding 100 cases with drains were included in analysis for a cohort of 200 patients. Variables analyzed included pre-operative patient and tumor characteristics and post-operative outcomes, including serum and drain creatinine on post-operative day 1, estimated glomerular filtration rate (eGFR) at 1 day and 1 month after surgery, length of hospital stay(LOS), and complications. Complications were categorized according to the Clavien-Dindo classification.
Results: For patients in whom a drain was placed intraoperatively, mean drain duration was 2.2 days. Mean drain creatinine to serum creatinine ratio was 1.06. 3% of patients had a drain creatinine to serum creatinine ratio > 1.2 prior to removal of drain. All drains were removed prior to hospital discharge. There was no difference in median patient age, sex, body mass index, percent of patients with hypertension/diabetes, ASA score, pre-operative eGFR, or pre-operative hemoglobin. Renal mass size was larger in drain patients compared to those without drains(3.2 vs 2.8 cm, p 0.013). Warm ischemia time was longer in drain patients (20.5 vs 18 minutes, p=0.0042) and EBL was higher in drain patients than patients without drains (400 vs 300 mL, p= 0.021). More patients with drains placed had a collecting system entry (89%) compared to those without drains placed (54%)(p < 0.0001). Median LOS was longer in drain patients(3.0 days) compared to no drain patients(2.0 days)(p=0.0007). There were fewer post-operative complications in drainless patients (13% overall; 4% â‰¥ grade III) compared to those with drains(29% overall; 10% â‰¥ grade III)(p=0.0065). At one month post-operatively, there was no difference in percent change in eGFR in drain patients (-11.4%) compared to those without drains(-12.7%)(p=0.8412). One patient who did not have an intraoperative drain placed required a post-operative drain for urine leak diagnosed 10 days after RAPN.
Conclusions: Omission of drains is safe in RAPN and may be associated with decreased hospital stay and fewer complications.