A Fast-Track Protocol Enables Same-day Discharge after Robotic Pyeloplasty and Unilateral or Bilateral Ureteral Reimplantation in Children.

Objective: To evaluate the safety and feasibility of a fast-track approach to decrease post-op length of stay (LOS) for pediatric patients undergoing robotic pyeloplasty or ureteral reimplantation (unilateral and bilateral) and to identify factors associated with same-day discharge.

Methods: We retrospectively reviewed children aged 0-18 years who underwent robotic pyeloplasty or ureteral reimplantation by a single surgeon at our institution between January 2021 and March 2024. A fast-track protocol to reduce post-op LOS was implemented in January 2022. The fast-track group was compared to the standard post-op care group in terms of baseline characteristics and post-op complications. Patients discharged same-day were also compared to patients who underwent an observation stay (overnight or longer).

Results: Ninety-five patients met inclusion criteria, 55 in the fast-track group and 40 in the standard post-op care group. The fast-track approach was associated with same-day discharge (47.3% vs 10%, p<0.0001). There were no significant differences in complications, ED visits or hospital readmissions between the groups. The main factor associated with same-day discharge was being the first case of the day. Neither type of surgery (pyeloplasty or ureteral reimplantation) nor laterality (unilateral vs bilateral in patients undergoing ureteral reimplantation) were associated with same-day discharge.

Conclusions: A fast-track approach for pediatric patients undergoing robotic pyeloplasty and ureteral reimplantation (unilateral and bilateral) is safe and feasible, may shorten post-op LOS and increase the likelihood same-day discharge. To our knowledge this is the first study to evaluate same-day discharge after bilateral robotic ureteral reimplantation.