Outpatient vs Inpatient Robotic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Abstract

Introduction:

Outpatient pathways are increasingly implemented, including robot-assisted partial nephrectomy (RAPN). However, the evidence supporting same-day RAPN originates from heterogeneous center series. As such, we synthesized the evidence in this systematic review and meta-analysis, comparing operative outcomes between outpatient and inpatient RAPN.

Methods:

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and AMSTAR guidelines. Three electronic databases (PubMed, Scopus, and Web of Science) were searched from their inception until June 18, 2025. Original studies reporting operative outcomes and relevant data, comparing the outpatient and inpatient RAPN, were included. We used risk ratio (RR) and mean difference (MD) with their 95% confidence interval (CI) to compare dichotomous and continuous outcomes, respectively. The primary outcome was the major postoperative complication rate, and the secondary outcomes were overall complications, unscheduled visits, and readmission after operation.

Results:

A total of 168 titles and abstracts were included for initial screening. The full-text assessment was conducted on 22 articles, and 6 remained in our final analysis. This represented 1559 patients, of which 830 (53.24%) and 729 (46.76%) composed the outpatient and inpatient cohorts, respectively. In the outpatient group, the proportion of low ASA scores (I–II) was significantly higher than that in the inpatient group (RR = 1.41, 95% CI: 1.13–1.77, P = 0.003). Regarding perioperative outcomes, the outpatient had shorter operative time (MD = −19.4 minutes, 95% CI −34.48 to 4.27, P = 0.012), shorter warm ischemia time (MD = −4.94 minutes, 95% CI: −9.45 to 0.43, P = 0.032), and more pathologic T1 stage (RR = 1.06, 95% CI: 1.01–1.11, P = 0.018). After an operation, outpatients were at lower risk of major complications (RR = 0.44, 95% CI: 0.24–0.81, P = 0.009), but more likely to have unscheduled visits (RR = 2.78, 95% CI: 1.24–6.21, P = 0.013). Overall and minor complications, postoperative readmission, transfusion rates, and estimated blood loss were comparable between the two groups.

Conclusions:

Based on the available evidence, outpatient RAPN could be a safe and feasible option for carefully selected patients, provided an appropriate postoperative support is available.