Pain management and early recovery after robot-assisted partial nephrectomy in a short-stay ambulatory pathway: a single-center retrospective cohort study.

To evaluate a bundled multimodal analgesia-centered management protocol within a short-stay ambulatory robot-assisted partial nephrectomy (RAPN) pathway and to assess postoperative pain control, rescue analgesic requirements, analgesia-related adverse reactions, early recovery, and short-term safety. This retrospective cohort study analyzed the clinical data of 161 consecutive patients who underwent RAPN at our hospital between June 2021 and June 2025. The short-stay ambulatory pathway was defined as a fast-track pathway with postoperative observation and planned discharge within approximately 48 h after surgery, rather than true same-day discharge. According to the perioperative care model received, patients were divided into a short-stay ambulatory RAPN group (n = 84) and a conventional inpatient RAPN group (n = 77). Baseline characteristics, tumor complexity, surgical indicators, analgesic medication, postoperative pain scores, adverse events, recovery outcomes, and 30-day safety outcomes were compared. Continuous variables are presented as medians (interquartile ranges), and categorical variables as numbers (percentages). Exploratory adjusted sensitivity analyses evaluated rescue analgesia, 24-hour moderate-to-severe pain, and time-weighted mean NRS from PACU through 48 h. Baseline age, BMI, tumor diameter, RENAL score, PADUA score, operative time, warm ischemia time, intraoperative blood loss, and perioperative renal function were generally comparable between the two groups. Preemptive non-opioid analgesia as a protocolized preoperative pathway component was used in 84 patients (100.0%) in the short-stay ambulatory group and in 0 patients (0.0%) in the conventional inpatient group. The ambulatory group had lower rescue analgesic requirements (7 [8.3%] vs. 21 [27.3%]) and lower pain scores at fixed postoperative time points and during discharge-anchored follow-up. The time-weighted mean NRS from PACU through 48 h was 3.16 (0.98, 4.95) versus 5.00 (3.00, 6.44). In exploratory adjusted analyses, the ambulatory pathway remained associated with lower rescue analgesia (adjusted OR 0.19, 95% CI 0.07-0.54), lower 24-hour moderate-to-severe pain (adjusted OR 0.39, 95% CI 0.20-0.78), and lower time-weighted mean NRS from PACU through 48 h (adjusted beta - 1.77, 95% CI -2.46 to -1.07). Among the 84 patients in the ambulatory group, 78 (92.9%) were discharged successfully as planned; no unplanned readmission or reoperation occurred within 30 days. In selected patients undergoing RAPN, a short-stay ambulatory pathway centered on bundled multimodal analgesia and extended nursing follow-up was associated with lower pain scores, reduced rescue analgesic use, earlier recovery, and acceptable short-term safety. These findings support feasibility in carefully selected patients but do not establish superiority; prospective multicenter validation and cost-effectiveness analyses are needed.