Calvillo-Ramirez Alejandro, Angulo-Lozano Juan Carlos, Acevedo-Rodriguez Jessica Edith, Vidal-Valderrama Carlos Esteban, Antunez-Perez Raul
Universidad Autonoma de Guadalajara, Facultad de Medicina, Zapopan, Jalisco, Mexico.
Department of Urology, Weill Cornell Medicine, New York, NY.
Urology. 2025 Jan;195:214-226. doi: 10.1016/j.urology.2024.09.036. Epub 2024 Sep 21.
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.
进行一项系统评价和荟萃分析，以评估日间经皮肾镜取石术（PCNL）与住院PCNL相比的有效性和安全性。
检索截至2024年1月27日的数据库，查找比较日间PCNL和住院PCNL结局的随机和非随机研究。当希金斯I²%异质性值>50%时，使用随机效应（RE）模型分析汇总数据；否则，采用固定效应模型。结果以比值比（OR）、平均差（MD）或标准化平均差（SMD）及95%置信区间（CI）报告。设定统计学显著性为P<0.05。
纳入1项随机对照试验（RCT）和14项观察性研究，共1574例患者。汇总结果显示，日间PCNL组患者的失血量减少（SMD -0.71，95% CI：[-1.31，-0.12]，P = 0.02）、输血率降低（OR 0.10，95% CI：[0.03，0.39]，P = 0.0008），总体和轻微并发症发生率较低（分别为OR 0.56，95% CI：[0.42，0.76]，P = 0.0002；以及OR 0.52，95% CI：[0.37，0.73]，P = 0.0002），手术时间更短（MD -11.46，95% CI：[-17.41，-5.50]，P<0.00001），总成本降低（MD -1597.18，95% CI [-2436.42，-757.93]，P = 0.0002）。两组之间的主要并发症、结石清除率（SFR）、急诊科就诊率和再入院率相似。
对于精心挑选的患者，日间PCNL是住院PCNL手术的一种可行且安全的替代方案，不会增加并发症风险或再入院率，且可能降低总成本。
