ObjectivesTo 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 MethodsThis 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.ResultsA 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.ConclusionsAmbulatory 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.

中文翻译：

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比较门诊和住院经皮肾镜取石术：系统评价和荟萃分析


目的通过当天出院 （SDD） 患者的亚组分析，探讨住院和门诊经皮肾镜取石术 （PCNL） 之间围手术期特征和术后结局的差异，总结已发表的门诊路径并比较成本和满意度数据。患者和方法本研究是根据系统评价和荟萃分析的首选报告项目指南完成的，并在国际系统评价前瞻性注册库 （PROSPERO： CRD42023438692） 中先验注册。非卧床 PCNL 定义为住院过夜 （≤23 h） 后出院的患者，SDD 被认为是术后第 0 天出院的亚组.结果系统评价共纳入 25 项研究，其中 12 项比较研究用于荟萃分析。我们有 2463 名患者的汇总人群，其中 1956 名 （79%） 门诊患者 （747 名 [30%] SDD） 和 507 名 （21%） 住院患者。门诊 PCNL 队列的总体并发症较少 （风险比 [RR] 0.65,95% 置信区间 [CI] 0.47-0.90;P = 0.010）;然而，主要并发症没有差异（即 Clavien-Dindo ≥III 级;RR 0.46;95% CI 0.17–1.21;P = 0.12）、急诊科就诊 （RR 1.09,95% CI 0.69-1.74;P = 0.71），30 天再入院 （RR 1.09,95% CI 0.54-2.21;P = 0.81）或任何时候再入院 （RR 1.00,95% CI 0.53-1.88;P = 0.99）。通过影像学定义，门诊 PCNL 队列更有可能无结石 （RR 1.35,95% CI 1.09-1.66;P = 0.005）;然而，当无结石包括任何定义时，无结石率没有差异（RR 1.10,95% CI 0.98-1.23;P = 0.10）。SDD 的亚组分析未导致任何显著差异。节省的成本从 932 美元起。37 比平均 （标准差） 每箱 5327 （442） 美元。没有研究报告患者满意度数据。结论门诊 PCNL 似乎是特定患者安全有效的模型。选择偏倚可能影响门诊结局;然而，这支持了当前门诊纳入标准的整体安全性。