Comparative Outcomes of Day-case Percutaneous Nephrolithotomy Versus Conventional Inpatient Surgery: A Systematic Review and Meta-analysis

• Published in: Urology (Ridgewood, N.J.)
• Main Authors: Calvillo-Ramirez, Alejandro, Angulo-Lozano, Juan Carlos, Acevedo-Rodriguez, Jessica Edith, Vidal-Valderrama, Carlos Esteban, Antunez-Perez, Raul
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 21.09.2024
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2024.09.036

To conduct a systematic review and meta-analysis to evaluate the effectiveness and safety of PCNL performed as a day-case surgery in comparison to inpatient PCNL. Databases were searched up to January 27, 2024, for randomized and non-randomized studies comparing outcomes between day-case PCNL and inpatient PCNL. Pooled data were analyzed using a random-effects (RE) model when Higgins I2% heterogeneity values were >50%; otherwise, a fixed-effects model was employed. The results were reported as odds ratios (OR), mean difference (MD) or standardized MD (SMD) with 95% confidence intervals (CI). Statistical significance was set at P <.05. One randomized controlled trial (RCT) and 14 observational studies totaling 1574 patients were included. Pooled results revealed that patients in the day-case PCNL group experienced reduced blood loss (SMD −0.71 95% CI: [−1.31, −0.12] P .02) and transfusion rates (OR 0.10 95% CI: [0.03, 0.39], P .0008), lower overall and minor complications (OR 0.56, 95% CI: [0.42, 0.76], P .0002, and OR 0.52, 95% CI: [0.37, 0-73], P .0002, respectively), shorter operative time (MD −11.46, 95% CI: [−17.41, −5-50], P <.00001), and reduced total costs (MD −1597.18, 95% CI [−2436.42, −757.93], P .0002). Major complications, stone-free rate (SFR), emergency department (ED) visits, and readmission rates were similar between the groups. Day-case PCNL is a feasible and safe alternative to inpatient PCNL surgery in carefully selected patients, without increasing the risk of complications or readmission rates, and is likely to reduce total costs.