Standard Percutaneous Nephrolithotomy as Day care Surgery. A Single Center Experience

Background: Percutaneous Nephrolithotomy (PCNL) is a well-defined treatment modality for kidney stones. The present study evaluates the feasibility of PCNL as a day care surgery advocating patient selection and perioperative care to ensure safe and efficacy. Objectives: To assess the feasibility, safety and efficacy of a standard PCNL as a day care procedure, including perioperative complications, stone clearance and factors that have potential impact for day care PCNL success. Methods: Retrospective cohort study done at Pakistan Kidney and Liver Institute and Research Centre over a period from November 2018 to July 2023 including patients of day care standard PCNL. Based on these predictors, the feasibility of day care surgery was compared between two groups (feasible cases and non-feasible cases) by conducting logistic regression analysis and statistical tests on the other variables. Results: Important predictors of day care PCNL feasibility included stone size (p = 0.021), blood transfusion (p = 0.024), duration of postoperative stay (p<0.001), and operative time (p = 0.001). Residual stone size was associated with a number of variables, including time in surgery, blood transfusion and initial stone size. A strong positive correlation was established between preoperative and postoperative haemoglobin levels. The operative time positively correlated with estimated blood loss and duration of postoperative stay. There was a negative correlation observed between estimated blood loss and preoperative haemoglobin levels. Conclusions: The findings of this study provide knowledge on the possibility and results of standard PCNL as a day care surgical intervention. The results support prior studies, highlighting stone size, blood management, and surgical effectiveness as the key determinants of day care PCNL viability. Better patient selection and management of the patient during the day care PCNL can make it a viable option for renal stone management