National trends in post-operative length of stay after pediatric robotic pyeloplasty and ureteral reimplantation.

BACKGROUND: Outpatient surgery offers benefits for patients, families, and healthcare systems, including higher satisfaction, reduced nosocomial infection risk, and decreased overall hospital costs and resource utilizations. In pediatric urology, robotic surgery has expanded minimally invasive options for complex reconstructions, with pyeloplasty and ureteral reimplantation being the most common procedures performed robotically. Although outpatient robotic approaches have been reported as safe and feasible, national trends and predictors of same-day discharge (SDD) in children remain poorly defined. Our objectives were to evaluate national trends in SDD in pediatric patients after robotic pyeloplasty (RAP) and robotic ureteral reimplantation (RAUR) compared to standard length discharge (SLD), and to identify factors associated with SDD in this patient population. METHODS: We conducted a retrospective cohort study using the Pediatric Health Information System (PHIS) database to identify patients <18 years old who underwent robot-assisted pyeloplasty (RAP) or robot-assisted ureteral reimplantation (RAUR) between January 2015 and December 2024. Patients were included if both diagnosis for ureteropelvic junction (UPJ) obstruction and procedure code for RAP or diagnosis code for vesicoureteral reflux (VUR) and procedure code for RAUR were present. The primary outcome was length of stay, categorized as SDD versus SLD. Statistical analyses included chi-square/Fisher's exact tests, independent t-tests, ANOVA, and multivariable logistic regression, with p < 0.05 considered significant. RESULTS: Of 3327 patients identified, 3252 met inclusion criteria (2718 RAP; 534 RAUR). For patients who underwent RAP, SDD ranged from 1.9 to 5.6% between 2016 and 2023, increasing to 10.3% in 2024. SDD patients had a higher proportion of Non-Hispanic or Latino patients, Self/other insurance coverage, and Midwest geographic location, and a lower proportion of patients with Medicaid insurance coverage. For RAUR, SDD ranged from 4.0 to 31.9%, with a peak in 2019. SDD patients had a higher proportion of Non-Hispanic or Latino patients, and Midwest geographic region. CONCLUSION: SDD after pediatric RAP and RAUR remains uncommon with no clear trends over time. Insurance status, ethnicity, and geographic region were significant predictors for SDD, highlighting variation in practice patterns. These findings underscore the need for standardized pathways to expand outpatient robotic surgery in appropriately selected pediatric patients and optimize patient-centered care.