Introduction:

At our institution, the target length of stay following robotic partial nephrectomy, laparoscopic radical nephrectomy, and robotic prostatectomy is discharge on post-operative day 1 (POD#1). We hypothesized that treating preoperative constipation will help combat the rate of postoperative ileus—one of the leading reasons for increased lengths of stay. Before launching a trial to treat preoperative constipation, we conducted a prospective observational study to determine the baseline level of constipation amongst this patient population as well as investigate a relationship between preoperative constipation and increased length of stay. The Patient Assessment of Constipation Symptoms (PAC-SYM) is a validated patient questionnaire that assesses constipation symptom burden on a spectrum with higher scores representing higher levels of constipation, but no specific threshold for diagnosis of constipation.

Methods:

Patients were asked to complete PAC-SYM surveys at a preoperative visit. Peri-operative data was collected prospectively including demographics, procedure performed, PAC-SYM scores, and length of stay.

Results:

A total of 99 patients met trial criteria. 31 patients underwent laparoscopic or robotic radical nephrectomy, 34 underwent robotic partial nephrectomy, and 34 underwent robotic prostatectomy. 18/99 (18%) patients stayed longer than POD #1. The overall pre-operative PAC-SYM score was 4.4. 32% (10/31) of lap nephrectomy patients, 24% (8/34) of partial nephrectomy patients, and 0% (0/34) radical prostatectomy patients stayed longer than POD#1. Preoperative PAC-SYM scores for lap nephrectomy, robotic partial nephrectomy, and robotic prostatectomy were 4.7, 4.1, and 4.2, respectively. Radical and partial nephrectomy patients with a PAC-SYM score of 5 or greater had a 36% chance of staying longer than POD#1 compared to 23.3% with a PAC-SYM score <5. Overall, patients who discharged on POD#1 had an average preoperative PAC-SYM score of 4.1 compared to 5.3 for those who did not, although this was not statistically significant. The reasons for delay in discharge were abdominal distension/pain (10), nausea (4), and post-operative complication (2), dizziness (1), and patient preference (1).

Conclusion:

On average, patients with delayed discharge after minimally invasive surgery had higher PAC-SYM scores compared to those discharged on post-operative day #1. Patients with a PAC-SYM score <5 undergoing nephrectomy (radical or partial) were 11% more likely to discharge on POD#1. Further studies will elucidate the potential role of treating constipation preoperatively to decrease post-operative length of stay.

Funding: N/A