Introduction: Percutaneous nephrolithotomy (PCNL) surgery has traditionally been performed with at least an overnight stay in a hospital for a variety of reasons including medical, social and surgeon preferences. There continues to be a trend toward moving surgical procedures to an ambulatory setting. To date there have been no criteria established to ascertain which patients require inpatient hospitalization after PCNL. The purpose of this review is to determine what factors lead to inpatient versus outpatient PCNL surgery.
Methods: We reviewed 259 consecutive PCNL procedures performed from December 2018 to October 2019 in both a hospital and ASC setting by a single surgeon. 185 cases were performed in an ASC and 74 were performed in the hospital. These patients were separated into two groups, those that required hospital admission (n=31) or were transferred from ASC (n=1) and those that were either discharged same day from the hospital (n=43) or ASC (n=184). Demographics, co-morbidities, stone characteristics, and operative times were compared with univariate analyses and odds ratios were calculated to find those factors associated with inpatient hospitalization.
Results: Overall 32 patients (12.4%) required inpatient hospitalization after PCNL. Patients requiring admission were more likely to have a positive preoperative urine culture (OR=5.37, p<0.0001), be on anticoagulation (OR=8.42, p=0.002), have an American Society of Anesthesiologists Physical Status Classification System (ASA) level >2 (OR=9.2, p=0.0001), stone burden >mean of 40mm (OR=2.98, p=0.0061), and total operative time > mean of 125 min (OR=5.32, p<0.0001).
Conclusions: ASA level >2 and preoperative anticoagulation predict for inpatient hospitalization. This correlates with increased cardiac anesthetic risk. Operative time >125 min and stone burden >40mm also predict inpatient hospitalization, reflecting increased case complexity. Finally, having a pre-PCNL positive urine culture predicts for inpatient hospitalization, which correlates with concerns for post-operative infectious complications. Continued efforts to understand patient and surgical factors that are favorable for same day discharge PCNL can lead to the development of criteria to determine which patients are best suited for ambulatory surgery. Source of