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PREDICTIVE FACTORS FOREARLY DISCHARGE (&lt24H)AND READMISSION FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IN CHILDREN.
Paulo R. Moscardi, MD1, Ruben Blachman-Braun, MD1, Natalia Ballesteros, MD2, George A. Ransford, MD2, Mariarita Salvitti, MD2, Alireza Alam, MD2, Kristin Kozakowski, MD2, Rafael Gosalbez, MD2, Andrew Labbie, MD2, Miguel A. Castellan, MD2.
1Jackson Memorial Hospital, Miami, FL, USA, 2Nicklaus Children's Hospital, Miami, FL, USA.

BACKGROUND: The minimally invasive surgery (MIS) for correction of UPJ obstruction in children (laparoscopic or robotic assisted), has significantly improved the postoperative management of these patients. Prior studies showed that these techniques allowed patients a faster recovery and an early discharge home, but not many times others factors such as early readmission rate are reported. In this present study we sought to examine the factors associated with late discharge (>24h) and readmission in children that underwent robotic-assisted laparoscopic pyeloplasty.
METHODS: We performed a retrospective chart review including all children who underwent robotic-assisted pyeloplasty from 2012 to 2018 in our center. All patients underwent a transperitoneal Anderson-Hynes technique with a double-J stented in a retrograde fashion. Demographic and clinical perioperative data and outcomes were recorded and analyzed. Descriptive statistics and a non-adjusted risk analysis were performed to evaluate the factors associated with late discharge (>24h), readmission and complications within the first 30 days after the procedure.
RESULTS: From October 2012 to September 2018, 123 pyeloplasties were identified. Of this group, 89 patients (72%) stayed less then 24 hours post-surgery in the hospital (table 1). No statistical difference was observed regarding most variables including age, gender, presence of renal anomalies (i.e., horseshoe kidney, pelvic, redo cases) or secondary procedures at the time of the pyeloplasty (like pyeloscopy for removal of stones). Furthermore, no increased rates of readmission or complications (18 complications were observed, being all minor - Clavien <3) were seen for the patients with late discharge (>24h) when compared to ones who had a longer length of stay (LOS). Additionally, a decreased operative time was seen for the patients discharged earlier, however this was not statistically significant. Of the variables analyzed, only late cases (more team surgical experience) was statistically associated with LOS and, first 55 patients have a longer LOS (OR = 7.28 CI 95%: 1.36 7.09, p = 0.007).
CONCLUSIONS: Robotic-assisted pyeloplasty for children are associated with high rate of early recovery, short hospital stay, low readmission and complication rate. Although not statistically significant, patients with short OP time also had a shorter LOS. An increased LOS was observed in the initial patients of our series, this is most likely explained because the initial learning curve of all the team for the procedure itself and the postop management.
Table 1: Clinical,demographics and outcomes of the overall populations and comparation between the group with a length of stay of < 24 hours and > 24 hours.

Overall
n = 123 (%)
Hospital stay <24h
n = 89 (%)
Hospital stay >24h
n = 34 (%)
p-value
Age at surgery (months)104 [48-163]104 [47-164]92 [49-158]0.743
Infants (0-12)9 (7.3)7 (7.9)2 (5.9)
Toddlers (13-36)15 (12.2)10 (11.2)5 (14.7)
Prepubertal (37-156)63 (51.2)46 (51.7)17 (50)
Adolescents (157-216)36 (29.3)26 (29.2)10 (29.4)0.942
Males84 (68.3)64 (71.9)20 (58.8)0.163
Laterality
Right50 (40.7)37 (41.6)13 (38.2)
Left73 (59.3)52 (58.4)21 (61.8)0.736
Length of follow-up (months)9 [4-21]9 [4-19.3]15 [4-34.5]0.274
Pyeloscopy8 (6.5)5 (5.6)3 (8.8)0.683
Renal anomaly10 (8.1)5 (5.6)5 (14.7)0.137
Davinci System
Si55 (44.7)33 (37.1)22 (64.7)
Xi68 (55.3)56 (62.9)12 (35.3)0.006
OR time (minutes)183 [161-228]181 [159-218]192 [173-244]0.082
Postoperative complication 30 days18 (14.6)10 (11.2)8 (23.5)0.095
Readmission 7 (5.7)5 (5.6)2 (5.9)1.000

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