Pd10-05 a Multi-Center Randomized Controlled Trial of Ambulatory Versus Inpatient Percutaneous Nephrolithotomy

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) II (PD10)1 May 2024PD10-05 A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL OF AMBULATORY VERSUS INPATIENT PERCUTANEOUS NEPHROLITHOTOMY Gregory Hosier, Darren Beiko, Heiko Yang, Wilson Sui, David Bayne, Marshall Stoller, and Thomas Chi Gregory HosierGregory Hosier , Darren BeikoDarren Beiko , Heiko YangHeiko Yang , Wilson SuiWilson Sui , David BayneDavid Bayne , Marshall StollerMarshall Stoller , and Thomas ChiThomas Chi View All Author Informationhttps://doi.org/10.1097/01.JU.0001008748.59024.cb.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ambulatory percutaneous nephrolithotomy (PCNL) has been proposed as a means to speed patient recovery, decrease hospital stay time, and decrease cost compared to inpatient PCNL. Studies evaluating ambulatory PCNL have utilized highly selective selection criteria that preclude the vast majority of PCNL candidates. The goal of our study was to perform a high quality randomized controlled trial of ambulatory versus inpatient PCNL in a representative patient population including those with large stones (>4 cm), BMI>30, and ASA>2. METHODS: This was a multi-center, non-inferiority, randomized controlled trial of ambulatory versus inpatient PCNL at University of Manitoba and University of California, San Francisco. Patients were randomized prior to surgery stratified for ASA, BMI, stone size, and study site. Primary outcomes were complication and readmission rates within 4 weeks of surgery. Secondary outcomes were stone free rate (CT scan 4 weeks after surgery), quality of life (using WisQOL), and return to work time. RESULTS: Of 62 patients (32 ambulatory and 30 inpatient), mean age was 71, 48% were BMI>30, 41% were ASA 3/4, and 31% had stone size >4cm. There was no difference in our primary outcome of complication rate between those who underwent ambulatory (3%) and inpatient PCNL (10%, p=0.33, Table 1). Readmission rate within 4 weeks was not different between the ambulatory (3%) and inpatient group (4%, p=1). Stone free rate was not different between the ambulatory (72%) and inpatient group (73%, p=1). Mean recovery time in hospital after surgery was 2-3 hours in the ambulatory group versus 1 day in the inpatient group. The rate of patients who were able to return to work within 1 week was not different between the ambulatory group (88%) versus the inpatient group (80%, p=0.5). In those randomized to the ambulatory group, 3 (13%) required cross-over to the inpatient group for obstructive sleep apnea monitoring, elevated potassium monitoring, or surgical monitoring. CONCLUSIONS: Ambulatory PCNL has similar complication rates, stone free rates, and readmission rates compared to those who undergo inpatient PCNL. Our results support the use of ambulatory PCNL in patients with BMI>30, ASA>2, and stone size >4 cm who have typically been excluded from consideration for ambulatory PCNL in the past. Source of Funding: This work was supported in part by the 2022 Urology Care Foundation Research Scholar Award Program and the Endourological Society Raju Thomas, MD Award © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e187 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Gregory Hosier More articles by this author Darren Beiko More articles by this author Heiko Yang More articles by this author Wilson Sui More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...