Comparison of nursing-related assessment and patient outcomes between robot-assisted and Laparoscopic Partial Nephrectomy among Renal cell carcinoma patients in China

With the advancement and development of robotic surgery, robot-assisted laparoscopic partial nephrectomy (RAPN) was introduced several years ago in China. Till now, the impacts of RAPN on the nursing related assessment compared to laparoscopic partial nephrectomy (LPN) is limited. Previous studies showed that controversial finding for patients’ outcome between two surgeries. Thus, the aim of this study was to compare nursing related assessment outcomes and patients’ outcomes between renal cell carcinoma (RCC) patients after robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN), adjusted with covariates, in Shandong Province Hospital, China. This study was retrospective study, which recruited the patients who underwent LPN or RAPN from 1st January 2022 to 30th September 2023 in Shandong Province Hospital, China, using universal sampling method. Based on the sample size calculated, a total of 364 was needed (182 for each group). Barthel index (BI) self-care rating assessment, Braden pressure ulcer risk assessment, comprehensive pain assessment, Caprini score for risk assessment of VTE and risk assessment for unplanned extubation were collected using performa. Multiple linear regression was used to compare the nursing related assessment and patients’ outcomes between both surgeries, adjusted with covariates. A total of 302 patients (83.0%) included in this study, with 150 and 152 undergone LPN and RAPN respectively. In total, 302 patient records were used in this study, with 152 (50.3%) patients undergone RAPN and 150 (49.7%) patients undergone LPN. The Mean±SD of age were 54.6 ±12.5 years and 56.1 years ±11.0 years for RAPN and LPN groups respectively. Majority of patients were male (RAPN group: 67.1%, LPN group: 64.7%) and married (RAPN group: 94.7%, LPN: 98.0%). In both groups, majority of patients had no medical history. In comparison of nursing related assessment outcomes, patients in RAPN group had significantly higher Barthel index (BI) self-care rating assessment score and Braden pressure ulcer risk assessment score (β=7.63, 95%CI: 5.28,9.97, P<0.001; β=1.97,95%CI: 1.59,2.35, P<0.001; β=1.62, 95%CI: 0.14,3.1, P=0.03, β=1.97, 95%CI: 0.36, 0.97, P<0.001) at post-operation and before discharge, lower comprehensive pain assessment score at post-operation and before discharge (β=-1.45, 95%CI: -1.69, -1.21, P<0.001, β=-1.28, 95%CI: -1.50, - 1.07, P<0.001), lower Caprini score for risk assessment of venous thromboembolism (VTE) post-operation (β=-0.477,95% CI: -0.77, -0.19, P=0.001) but with higher Caprini score for risk assessment of VTE (β=0.73,95%CI: 0.47,0.99, P<0.001) before discharge compared with patients in LPN group, adjusted with covariates. For patients’ outcomes, patients with RAPN surgery had significantly 3.18 days longer staying in hospital (β=3.18, 95%CI: 3.26, 4.36, P<0.001) compared to patients in LPN group, adjusted with covariates. This study showed that patients undergone RAPN had significantly better nursing related assessment outcomes than patients with LPN, however with longer days of staying in hospital. Specific nursing care plan based on type of surgeries should be designed for patients in order to increase the chance of recovery among RRC patients at post operation.

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