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Comparing ambulatory to inpatient percutaneous nephrolithotomy: systematic review and meta‐analysis

医学 经皮肾镜取石术 回廊的 置信区间 子群分析 人口 相对风险 荟萃分析 围手术期 前瞻性队列研究 队列研究 急诊医学 系统回顾 内科学 外科 梅德林 经皮 环境卫生 政治学 法学
作者
Katie Du,Michael Uy,Alan Cheng,Braden Millan,Bobby Shayegan,Edward D. Matsumoto
出处
期刊:BJUI [Wiley]
标识
DOI:10.1111/bju.16601
摘要

Objectives 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. Patients and Methods 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. Results 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. Conclusions 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.
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