Du Katie, Uy Michael, Cheng Alan, Millan Braden, Shayegan Bobby, Matsumoto Edward
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
BJU Int. 2025 Mar;135(3):380-389. doi: 10.1111/bju.16601. Epub 2024 Dec 4.
To investigate the differences in perioperative characteristics and postoperative outcomes between inpatient and ambulatory percutaneous nephrolithotomy (PCNL) with a subgroup analysis of same-day discharge (SDD) patients, summarise published ambulatory pathways and compare cost and satisfaction data.
This study was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered a priori with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023438692). Ambulatory PCNL was defined as patients who were discharged after an overnight stay (≤23 h) and SDD was considered a subgroup discharged on postoperative Day 0.
A total of 25 studies were included in the systematic review, of which 12 comparative studies were utilised for meta-analysis. We had a pooled population of 2463 patients, of which 1956 (79%) ambulatory (747 [30%] SDD) and 507 (21%) inpatients. The ambulatory PCNL cohort had fewer overall complications (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.47-0.90; P = 0.010); however, there were no differences in major complications (i.e., Clavien-Dindo Grade ≥III; RR 0.46; 95% CI 0.17-1.21; P = 0.12), emergency department visits (RR 1.09, 95% CI 0.69-1.74; P = 0.71), 30-day readmission (RR 1.09, 95% CI 0.54-2.21; P = 0.81) or readmission at any point (RR 1.00, 95% CI 0.53-1.88; P = 0.99). The ambulatory PCNL cohort was more likely to be stone-free defined by imaging (RR 1.35, 95% CI 1.09-1.66; P = 0.005); however, when stone-free was inclusive of any definition there was no difference in stone-free rates (RR 1.10, 95% CI 0.98-1.23; P = 0.10). Subgroup analysis of SDD did not result in any significant differences. Cost savings ranged from $932.37 to a mean (standard deviation) $5327 (442) United States Dollars per case. No studies reported patient satisfaction data.
Ambulatory PCNL seems to be a safe and efficacious model for select patients. Selection bias likely influenced ambulatory outcomes; however, this supports overall safety of current ambulatory inclusion criteria.
探讨住院和门诊经皮肾镜取石术（PCNL）围手术期特征及术后结局的差异，并对当日出院（SDD）患者进行亚组分析，总结已发表的门诊手术流程，比较成本和满意度数据。
本研究按照系统评价和Meta分析的首选报告项目指南完成，并预先在国际前瞻性系统评价注册库（PROSPERO：CRD42023438692）注册。门诊PCNL定义为过夜住院（≤23小时）后出院的患者，SDD被视为术后第0天出院的亚组。
系统评价共纳入25项研究，其中12项比较研究用于Meta分析。我们汇总了2463例患者，其中1956例（79%）为门诊患者（747例[30%]为SDD），507例（21%）为住院患者。门诊PCNL队列的总体并发症较少（风险比[RR]0.65，95%置信区间[CI]0.47 - 0.90；P = 0.010）；然而，主要并发症（即Clavien - Dindo分级≥III级；RR 0.46；95% CI 0.17 - 1.21；P = 0.12）、急诊就诊（RR 1.09，95% CI 0.69 - 1.74；P = 0.71）、30天再入院（RR 1.09，95% CI 0.54 - 2.21；P = 0.81）或任何时间点的再入院（RR 1.00，95% CI 0.53 - 1.88；P = 0.99）均无差异。门诊PCNL队列通过影像学检查结石清除的可能性更大（RR 1.35，95% CI 1.09 - 1.66；P = 0.005）；然而，当结石清除包括任何定义时，结石清除率无差异（RR 1.10，95% CI 0.98 - 1.23；P = 0.10）。SDD的亚组分析未产生任何显著差异。成本节约范围为每例932.
