Evaluation of day-care versus inpatient mini-percutaneous nephrolithotomy: a propensity score-matching study

• Published in: Urolithiasis Vol. 48; no. 3; pp. 209 - 215
• Main Authors: Zhao, Zhijian, Sun, Hongling, Wu, Xiangkun, Cai, Chao, Liu, Yongda, Zeng, Guohua
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2020; Springer Nature B.V
• Subjects: Adult; Age; Ambulatory Surgical Procedures; Cardiovascular disease; Female; Health Care Costs; Hemoglobin; Hospitalization; Hospitals; Humans; Kidney Calculi - surgery; Laparoscopy; Male; Medical Biochemistry; Medicine; Medicine & Public Health; Middle Aged; Nephrolithotomy, Percutaneous - economics; Nephrolithotomy, Percutaneous - methods; Nephrology; Original Paper; Patient Readmission - statistics & numerical data; Patient safety; Patient satisfaction; Postoperative Complications - epidemiology; Propensity Score; Retrospective Studies; Surgeons; Surgery; Systematic review; Urine; Urology; Mini-percutaneous nephrolithotomy; Complications; Day-surgery
• ISSN: 2194-7228; 2194-7236
• DOI: 10.1007/s00240-019-01160-y

Day-care percutaneous nephrolithotomy (day-PCNL) is being performed more routinely, however, safety remains a concern. The purpose of this study was to compare the complication rate, readmission rate and medical cost saving between day-PCNL and inpatient-PCNL. A protocol for day-PCNL was applied. A retrospective review of 86 patients planned day-PCNL by one surgeon were conducted. Using propensity matching, 86 inpatients (minimum 2-day post-operative stay) treated with the same procedure were matched. For each cohort, 14-day occurrence of complications and unplanned readmissions were recorded and compared. More than 80% of patients had multiple or staghorn stones in both groups. There were no significant differences between stone-free rate, operative time, multiple-tracts use, hemoglobin drop (each p  > 0.05). Day- PCNL has a higher tubeless rate (60.8% vs. 24.4%, p  < 0.001) and were less costly (mean 2732 vs. 3828 dollars) compared with inpatient PCNL. Within 14 days post-operatively, 10 day-care patients (11.6%) and 13 inpatients (15.1%) experienced complications, with no difference in rate or severity. Four patients (4.6%) required full admission (longer than 24 h) and two patents needed readmission in day-PCNL group. Day-care PCNL was more cost-effective than in-patients PCNL, with no significant difference in complications along with very low unplanned readmission during the postoperative period of 14 days. Therefore, day-care PCNL is a cost-effective choice in selected patients.