Design and Evaluation of a Checklist for Day-care Percutaneous Nephrolithotomy

Our aim was to assess the feasibility of percutaneous nephrolithotomy (PCNL) as a day-care procedure and define the patient, stone, and perioperative characteristics of cases most suitable for this option.

In this prospective observational study, patients with renal stones undergoing PCNL were enrolled on the basis of predefined inclusion and exclusion criteria. Day-care PCNL was defined as discharge within 24 h after surgery. A day-care PCNL checklist with preoperative, intraoperative, and postoperative factors was formulated on the basis of the study outcomes.

A total of 347 consecutive patients underwent PCNL, of whom 300 underwent day-care PCNL. The mean age of the study population was 47 yr (standard deviation [SD] 13). Mean body mass index was 27 kg/m² (SD 13.52) and the mean Charlson Comorbidity Index (CCI) was 0.32 (SD 0.50). The mean stone volume was 1625 mm (SD 1376.24) and mean STONE score was 6.06 (SD 0.75). The tract size for 169 mini-PCNL procedures was ≤20 Fr and for 131 standard PCNL procedures was >20 Fr. The unplanned revisit rate was 6% and the readmission rate was 4.3%. The mean time from surgery to an unplanned revisit was 9 d (SD 5.34, range 3-20 d). Five patients had Clavien-Dindo grade 1, 12 had grade 2, and one had grade 3b complications. CCI score of 2 (p = 0.024) and stone volume >5000 mm³ (p = 0.021) were significantly associated with readmission. Diabetes (p = 0.039) was significantly associated with Clavien-Dindo grade ≥2 complications. The stone-free rate was 93%.

PCNL is safe and feasible as a day-care procedure when applied to a carefully selected patient cohort, and can reduce hospital length of stay while maintaining acceptable rates of readmission and Clavien-Dindo grade ≤2 complications. Our proposed day-care PCNL checklist can help in identifying the most suitable patients for this strategy and ensuring optimal outcomes.

We looked at outcomes for minimally invasive surgery to remove kidney stones performed as a day-care procedure in selected patients. We formulated a checklist that can help in selecting the patients most suitable for day-care surgery. This procedure is safe and feasible on a day-care basis for suitable patients.