(UroToday.com) The 2022 World Congress of Endourology and Uro-Technology (WCET) annual meeting included a moderated poster presented by Dr. Julio Davalos from Chesapeake Urology (Hanover, Maryland, USA) discussing the various postoperative factors that could contribute to a patient being discharged on the same day (or factors that would encourage inpatient overnight admission) as their admission following ambulatory percutaneous nephrolithotomy (PCNL).
Dr. Davalos began his presentation by discussing that nearly 20% of all patients at Chesapeake Urology and the University of Maryland Division of Urology undergo a PCNL in a hospital setting. Furthermore, he further elaborated that approximately 50% of these PCNL patients are discharged postoperatively the same day as their operation, demonstrating a potential underutilization of ambulatory surgical center (ASC) resources. For this reason, he and his team aimed for their study to identify clinical factors that would warrant safe postoperative admission following PCNL and what patients should be admitted for monitoring overnight.
The team first sought a prospective review of patients that underwent standard PCNL, then collected many of their demographic and clinical characteristics both at baseline and following admission, and finally conducted statistical analysis between the two cohorts. Multivariate logistic regression analysis was additionally utilized to tease out any independent associations that could exist with postoperative admission.
131 patients were identified and included in the study that underwent PCNL, with a further 52% of patients within this group being discharged on the same day as their operation. Dr. Davalos and his team found that patients that were admitted following PCNL rather than being discharged on the same day were often times older, demonstrated greater medical comorbidities, had a higher proportion of staghorn calculi and/or had larger stone burdens, tended to have greater intraoperative blood loss, and needed a greater number of renal accesses to clear their stone burden.
Dr. Davalos concluded his talk by mentioning that baseline disease comorbidity and concerns for postoperative infection were non-modifiable reasons for patients to be admitted postoperatively. Importantly, he stressed that many patients that had more dilated access sites, had a positive urine culture, needed anticoagulation to be paused preoperatively, and possessed larger volumes of intraoperative and postoperative bleeding ranked as being the strongest contributing factors for hospital admission.
Presented by: Julio G. Davalos, MD; Chesapeake Urology and University of Maryland Division of Urology, Hanover, Maryland, USA
Written by: Andrew S. Afyouni, BS, Medical Student, Department of Urology, University of California Irvine, @AndysheaAfyouni on Twitter during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.