Hackensack University Medical Center Achieves Same-Day Discharge Following Robotic Thymectomy

Shifts in drain protocols and pain management prioritization key to earlier release for 50% of patients

The Hackensack University Medical Center team has been able to push the envelope on thymectomy recovery, and now discharges half of patients the same day. Compared to the typical three-to-four-day hospital stay—even after minimally invasive surgery—this represents a significant shift.

When the thymus must be fully or partially removed, as in the case of myasthenia gravis and tumors of the thymus, the team uses robotic surgery and patients generally have a quick, smooth recovery—now with a same-day discharge for 50% of patients and just a one-night stay for most others.

Nabil Rizk, M.D., chief of Thoracic Surgery at Hackensack University Medical Center, credits the stepped-up discharge to the team’s ability to step back and critically view the “why” behind protocols from intake through recovery at home.

“Surgeons do what we’re taught, and what we learned is not always based on data,” Dr. Rizk explained.

Through this critical exercise, the team noticed that there was often very little drainage from the surgical site after three or four hours. They determined that pulling the drain at this point and performing an X-ray was sufficient. Earlier drain removal was the key procedural shift that allowed same-day release for most patients.

They also prioritized scheduling thymectomies in the morning and ensuring good pain management, which better prepares patients for same-day discharge.

With his encouragement to question the status quo, the thoracic surgery team is systematically reviewing various procedures to seek opportunities to shorten length of stay and maximize efficiencies while maintaining strong outcomes.

“For the most part, patients have been receptive,” Dr. Rizk noted, crediting the freedom to ambulate at home. The team’s new protocols also include a nurse navigator follow-up phone call once the patient is home to address any infection symptoms or pain management issues, such as constipation side effects of narcotics—questions and concerns that traditionally were addressed in-person, but are successfully managed by phone, the team has found.

Still, there are some patients whose insurance covers an overnight stay and prefer to remain in hospital care, which the care team accommodates. Dr. Rizk said this is now the primary reason some patients stay overnight.

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