Key result
Ambulatory ureteroscopy shows a 0% same-day emergent inpatient transfer rate in high-risk patients.
Why the study?
The safety of performing ureteroscopy at ambulatory surgery centers in high-risk patients with ASA score ≥ 3 was uncertain.
Does ureteroscopy at an ambulatory surgery center prevent emergency post-operative inpatient transfers in high-risk patients?
Cohort (n=100)
No
Does ureteroscopy at an ambulatory surgery center prevent emergency post-operative inpatient transfers in high-risk patients?
Ureteroscopy can be safely performed in selected high-risk patients (ASA ≥ 3) at ambulatory surgery centers without requiring same-day emergent inpatient transfer.
Supports ambulatory ureteroscopy in selected high-risk patients; hypothesis-generating and requires prospective validation before practice change.
PURPOSE: To determine whether unhealthy patients undergoing ureteroscopy at an ambulatory surgery center are at high risk of emergency post-operative transfer to an inpatient setting. METHODS: Records of 100 consecutive high-risk patients undergoing URS at a free-standing ambulatory surgery center (ASC) were reviewed. Patients were considered high-risk if their American Society of Anesthesiologists score (ASA) was ≥ 3. Perioperative risk was assessed using the Charlson Comorbidity Index (CCI) and the 5-factor Modified Frailty Index (mFI-5). Post-operative complications requiring emergent inpatient transfer on the day of surgery and complications within 30-days were recorded. RESULTS: The median age for patients was 61.4 years (IQR: 54.7-68.4) and median BMI was 31.0 (IQR: 26.6-37.2). Common chronic illnesses were hypertension (74%), COPD (44%), diabetes (40%), and peripheral vascular disease (14%). All patients were considered high-risk by ASA score. By CCI, 28% of patients were high-risk, 23% were significant risk and 49% were mild risk, with median score of 3 (IQR 1-5). By mFI-5, 20% of patients were high-risk, with median score of 2 (IQR 1-2). No patient required emergent transfer on the day of surgery. Within 30 days postoperatively, 15 patients presented to the Emergency Department (ED) and 5 were admitted. mFI-5 and CCI were not predictive of ED visits. CONCLUSION: Selected high-risk patients with unfavorable ASA, mFI-5, and CCI undergoing URS within an ASC are unlikely to require emergent, post-operative transfer to an inpatient facility.
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Cook et al. (2025) conducted a cohort in Kidney or ureteral stones (n=100). Ureteroscopy at an ambulatory surgery center was evaluated on Emergent inpatient transfer on the day of surgery. Among high-risk patients (ASA ≥ 3) undergoing ureteroscopy at an ambulatory surgery center, 0% required emergent post-operative transfer to an inpatient facility on the day of surgery.
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