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

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Abstract

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.

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Funding

This study was supported in part by research grants from National Natural Science Foundation of China (no. 81600542).

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Author notes

  1. Yongda Liu & Guohua Zeng

    Present address: Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China

  2. Zhijian Zhao and Hongling Sun contribute equally to this work as the co-first authors.

Authors and Affiliations

  1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, Guangzhou, China

    Zhijian Zhao, Hongling Sun, Xiangkun Wu, Chao Cai, Yongda Liu & Guohua Zeng

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  1. Zhijian Zhao
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Correspondence to Yongda Liu or Guohua Zeng.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Zhao, Z., Sun, H., Wu, X. et al. Evaluation of day-care versus inpatient mini-percutaneous nephrolithotomy: a propensity score-matching study. Urolithiasis 48, 209–215 (2020). https://doi.org/10.1007/s00240-019-01160-y

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  • DOI: https://doi.org/10.1007/s00240-019-01160-y

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