Ambulatory Percutaneous Nephrolithotomy: Initial Series in Iran

Background: Percutaneous nephrolithotomy (PCNL) procedures in the United States typically cost between 9000 to 16000 USD. In developing countries like Iran, healthcare performance is hindered by issues such as high bed occupancy rates. Therefore, performing PCNL in an outpatient setting could significantly reduce surgical costs and improve healthcare outcomes by reducing bed occupancy and associated complications. Objectives: This study aimed to explore the feasibility of same-day discharge for selected PCNL patients. Methods: Out of 142 patients, 32 were discharged within 12 hours post-operation (Study Group), while 32 randomly selected patients from the remaining 110 served as the control group. Same-day discharge criteria included stable vital signs, tolerance to oral intake, appropriate mobility, and normal laboratory results. Exclusion criteria encompassed the need for red blood cell transfusion, hemoglobin drops exceeding 2 mg/dL, and abnormal post-operative laboratory findings. Results: Patient characteristics and medical histories did not significantly differ between the study and control groups. Additionally, stone laterality (P-value = 0.606), location (P-value = 0.731), size (P-value = 0.334), and density (P-value = 0.065) showed no significant differences between the two groups. The post-surgical observation period in the study group (mean: 7.88 hours) was significantly shorter than that in the control group (mean: 62 hours) (P-value < 0.001). The mean hemoglobin level change was 1.48 mg/dL (SD: ± 1.02) in the study group and 1.31 mg/dL (SD: ± 0.91) in the control group. Similarly, the change in creatinine levels was 0.13 ± 0.04 in the study group and 0.23 ± 0.03 in the control group. Conclusions: This study demonstrates that outpatient PCNL procedures are feasible without increasing perioperative complications. However, careful patient selection based on strict criteria is crucial for successful implementation.