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The following is a summary of “Comparative Outcomes of Day-Case Percutaneous Nephrolithotomy vs Conventional Inpatient Surgery: A Systematic Review and Meta-Analysis,” published in the September 2024 issue of Urology by Calvillo-Ramirez et al.
This systematic review and meta-analysis evaluated the effectiveness and safety of percutaneous nephrolithotomy (PCNL) when performed as a day-case surgery compared to traditional inpatient PCNL. A comprehensive search of relevant databases was conducted until January 27, 2024, identifying randomized controlled trials (RCTs) and observational studies that compared clinical outcomes between day-case and inpatient PCNL. The analysis incorporated randomized and non-randomized studies, employing a Random-Effects (RE) model when heterogeneity (Higgins I2) exceeded 50% and a Fixed-Effects model when heterogeneity was lower. Data were synthesized and reported as odds ratios (OR), mean differences (MD), or standardized mean differences (SMD), all with 95% CI. A p-value of less than 0.05 was considered statistically significant.
A total of 15 studies, including one RCT and 14 observational studies, with 1,574 patients, were analyzed. The pooled results demonstrated that patients undergoing day-case PCNL experienced several benefits over those receiving inpatient PCNL. Notably, the day-case group exhibited significantly lower blood loss (SMD -0.71, 95% CI: [-1.31, -0.12], p = 0.02) and a reduced need for blood transfusions (OR 0.10, 95% CI: [0.03, 0.39], p = 0.0008). In addition, the day-case cohort had fewer overall complications (OR 0.56, 95% CI: [0.42, 0.76], p = 0.0002), fewer minor complications (OR 0.52, 95% CI: [0.37, 0.73], p = 0.0002), shorter operative times (MD -11.46 minutes, 95% CI: [-17.41, -5.50], p < 0.00001), and reduced total costs (MD -1597.18, 95% CI: [-2436.42, -757.93], p = 0.0002). Major complications, stone-free rates (SFR), emergency department visits, and readmission rates showed no significant differences between the two groups.
In conclusion, this analysis indicates that day-case PCNL is a safe and effective alternative to inpatient PCNL in appropriately selected patients. It offers the potential for reduced blood loss, lower complication rates, shorter surgical times, and significant cost savings without increasing the risk of major complications, readmission, or emergency department visits. These findings support the feasibility of day-case PCNL in clinical practice, suggesting that it could be a viable option for optimizing healthcare resources while maintaining patient safety and treatment efficacy.
Source: sciencedirect.com/science/article/abs/pii/S0090429524008306
