Beksac Alp Tuna, Okhawere Kennedy E, Meilika Kirolos, Ige Olajumoke A, Lee Jennifer Y, Lovallo Gregory G, Ahmed Mutahar, Stifelman Michael D, Eun Daniel D, Abaza Ronney, Badani Ketan K
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
J Endourol. 2020 Sep;34(9):964-968. doi: 10.1089/end.2020.0325. Epub 2020 Aug 25.
Closed drains have traditionally been placed after partial nephrectomy because of risks of bleeding and urine leak. We sought to study the safety of a nonroutine drain (NRD) approach after transperitoneal robotic partial nephrectomy (RPN). From a multi-institutional database, we have analyzed the data of 904 patients who underwent RPN. Five hundred forty-six (60.40%) patients underwent RPN by a surgeon who routinely placed drains. Three hundred fifty-eight (39.60%) patients underwent RPN by a surgeon who did not routinely placed drains. Perioperative outcomes, length of stay (LOS), and readmission rates were compared between the two groups. Baseline characteristics, perioperative, and postoperative outcomes were compared using Mann-Whitney U test, chi-square test, and Fisher's exact test. Patients in the NRD group were more likely to have higher body mass index (30.10 kg/m 28.07 kg/m; < 0.001), higher tumor size (3.0 cm 2.5 cm; = 0.001), and higher renal score (8 7; < 0.001). Rate of transfusion (0.00% NRD 0.56% RD; = 0.157) and overall complication (7.33% NRD 7.82% RD; = 0.782) were comparable. Median hospital stay is 1 day for both groups. Readmission rate was also similar (0.55% NRD 1.40% RD; = 0.279). In a multivariable analysis, NRD approach was associated with shorter length of hospital stay (incidence rate ratio [IRR] - 0.72, < 0.001). An NRD approach for RPN yielded a decreased LOS and similar perioperative outcomes. Placement of surgical drains should be based on individual circumstances, and not required on a routine basis.
由于存在出血和尿液渗漏风险，传统上在部分肾切除术后会放置闭式引流管。我们试图研究经腹机器人辅助部分肾切除术（RPN）后采用非常规引流（NRD）方法的安全性。我们从一个多机构数据库中分析了904例行RPN患者的数据。546例（60.40%）患者由常规放置引流管的外科医生进行RPN手术。358例（39.60%）患者由不常规放置引流管的外科医生进行RPN手术。比较了两组患者的围手术期结局、住院时间（LOS）和再入院率。使用曼-惠特尼U检验、卡方检验和费舍尔精确检验比较了基线特征、围手术期和术后结局。NRD组患者更有可能具有更高的体重指数（30.10kg/m²对28.07kg/m²；P＜0.001）、更大的肿瘤大小（3.0cm对2.5cm；P = 0.001）和更高的肾评分（8分对7分；P＜0.001）。输血率（NRD组0.00%对RD组0.56%；P = 0.157）和总体并发症发生率（NRD组7.33%对RD组7.82%；P = 0.782）相当。两组的中位住院时间均为1天。再入院率也相似（NRD组0.55%对RD组1.40%；P = 0.279）。在多变量分析中，NRD方法与较短的住院时间相关（发病率比[IRR] - 0.72，P＜0.001）。RPN采用NRD方法可缩短住院时间且围手术期结局相似。手术引流管的放置应根据个体情况而定，无需常规放置。
