O3333: Comparison of Same Day Discharge versus Inpatient Hospitalization after Upper Urinary Tract Robotic Reconstruction in Pediatric Urology

Background: Same day discharge (SDD) following minimally invasive procedures has increased in popularity within pediatric urology. Initial studies have demonstrated safety and feasibility of SDD, but no studies have compared outcomes for SDD and inpatient (IP) robotic-assisted laparoscopic operations in pediatric patients. This study aims to compare key clinical outcomes between SDD and IP for robotic-assisted laparoscopic pyeloplasty (RALP) and robotic-assisted laparoscopic ureteroureterostomy (RUU) in children.

Methods: We reviewed patients who underwent RALP and RUU at our pediatric hospital from January 2018 to December 2024. Demographic and clinical data were analyzed. We compared 90-day Clavien-Dindo complications and re-admissions, unplanned outpatient phone calls and ED/clinic visits, length of stay (LOS), post-operative narcotic utilization and re-intervention rates in SDD and IP robotic operations.

Results: A total of 167 patients were included (32 SDD and 135 IP). RALPs comprised 148 (88.6%) of the total cases compared to 19 (11.4%) RUU. Median length of stay was 7.4 hours for SDD and 29.7 hours for IP (p < 0.001). Median follow up was 138 days for SDD and 510 days for IP (p < 0.001). Demographics were similar between groups (Table 1). Median distance from the hospital was 45 miles for SDD and 53 miles for IP (p = 0.036). There were no differences in 90-day outpatient phone calls (65.6% SDD vs. 56.3% IP, p = 0.426), unplanned ED/clinic visits (28.1% SDD vs. 26.7% IP, p = 0.828), complications (18.8% SDD vs. 22.9% IP, p = 0.81) and re-admissions (9.4% SDD vs. 8.1% IP, p = 0.733) (Table 2). Most 90-day complications were Clavien-Dindo grade 1-2 (100% SDD and 97% IP), with one 90-day Clavien-Dindo grade 3 complication for IP (ureteral stent replacement). Patients in both groups had similar rates of intraoperative ureteral stent placement (93.8% SDD vs. 97% IP, p = 0.324), discharge with a foley catheter (9.4% SDD vs. 4.4% IP, p = 0.376), and re-intervention (3.1% SDD vs. 3.0% IP, p = 0.961). There was no significant difference in post-operative narcotic utilization between the two groups (43.8% SDD vs. 62.2% IP, p = 0.07). However, there was a significantly greater milligram morphine equivalents (MME)/kilogram (kg) value in IP vs. SDD (0.116 SDD vs. 0.222 IP, p = 0.002).

Conclusion: Same-day discharge following RALP and RUU is feasible and safe, with significantly shorter LOS and comparable rates of complications, readmissions, unplanned clinic/ED visits, outpatient calls, and reinterventions compared to IP procedures. SDD should be considered for appropriately selected pediatric patients undergoing RALP or RUU. Longer-term follow-up is required to validate our findings.