Ambulatory PCNL may be cost-effective compared to Standard PCNL

Introduction & Objective: In March 2020, hospitals across America locked down to prevent the spread of COVID-19. This resulted in catastrophic financial losses and massive surgical backlog. While multiple groups have shown that ambulatory percutaneous nephrolithotomy (aPCNL) is safe and feasible, to our knowledge, a cost-analysis comparing aPCNL against standard PCNL (sPCNL) has not been performed. Prior to March 2020, our group was not performing routine aPCNL, but to conserve hospital resources, we performed aPCNL more often. Our objective was to compare the safety and cost-effectiveness of sPCNL vs. aPCNL. Methods: 98 patients underwent PCNL at Indiana University Methodist hospital, a tertiary referral center, by three expert surgeons from January 2020 to September 2020. sPCNL (n = 75) and aPCNL (n = 23). All patients had at least 30-days of follow up. The primary outcome of the study was to compare the 30-day rates of ED-visits, readmissions, and complications between sPCNL and aPCNL. Secondary outcomes included: cost analysis and stone free rates (SFRs). Statistical analysis was performed using SPSSv26 using independent t-tests for continuous variables and chi-square analyses for categorical variables. Results: We found no difference in 30-day ED-visits, readmissions, or complications between the two groups. aPCNL resulted in cost savings of $5689 ± 237 per case, a 29.6% reduction. Conclusions: aPCNL appears safe to perform and does not have a higher rate of ED-visits or readmissions compare to sPCNL. aPCNL also is also costeffective compared to sPCNL. Patients undergoing same-day discharge were not at higher risk of EDvisits or readmission to the hospital. (Table Presented).

Assessment of emergency department urolithiasis presentations during the COVID-19 pandemic

Introduction & Objective: During the unprecedented COVID- 19 pandemic, there have been major changes in healthcare delivery, patients seeking care and access to care. We sought to determine if there were differences in Emergency Department (ED) presentations for urolithiasis and their triage from the ED. Methods: We assessed the all ED presentations and those for urolithiasis (defined as codes N20.0 and N20.1) from January 2019 through December 2020 at four hospitals (one primary, two secondary and one tertiary/quaternary care) in a single hospital network in the Indianapolis metro area. We also assessed the patient's disposition, either discharged from the ED or admitted to the hospital. Results: There were 109,656 total ED presentations in 2019 and 1369 ED presentations for urolithiasis (12.5%). In 2020, there were 94143 total ED presentations with 1212 for urolithiasis (12.9%). There was no significant difference between total stone presentation between the 2019 and 2020. In 2020, there were significant increases in the rate of stone presentations in May (1.39% vs 0.010%, p = 0.02) and August (1.64% vs 1.13%, p = 0.0035). There was a significant decrease in the rate of stone presentation in December 2020 compared to December 2019 (0.91% vs 1.34%, p = 0.0096). Figure 1 demonstrates the monthly ED Visits for urolithiasis compared between 2019 and 2020, with the monthly COVID-19 cases in Indiana. There was a decline in total visits 71.5% of visits were dismissed from the ED in 2019 compared to 70.2% in 2020. There were no differences in the rates of ED discharge or hospital admission on a monthly basis between 2019 and 2020. Conclusions: Within a hospital system in the Indianapolis metropolitan area, there does not appear to be a change in ED stone presentations or disposition patterns between 2019 and 2020 despite the COVID-19 pandemic. (Table Presented).

Ambulatory PCNL may be cost-effective compared to standard PCNL

INTRODUCTION AND OBJECTIVE: In March 2020, hospitals across America locked down to prevent the spread of COVID-19. This resulted in catastrophic financial losses and massive surgical backlog. While multiple groups have shown that ambulatory percutaneous nephrolithotomy (aPCNL) is safe and feasible, to our knowledge, a cost-analysis comparing aPCNL against standard PCNL (sPCNL) has not been performed. Prior to March 2020, our group was not performing routine aPCNL, but to conserve hospital resources, we performed aPCNL more often. Our objective was to compare the safety and cost-effectiveness of sPCNL vs. aPCNL. METHODS: 98 patients underwent PCNL at Indiana University Methodist hospital, a tertiary referral center, by three expert surgeons from January 2020 to September 2020. sPCNL (n=75) and aPCNL (n =23). All patients had at least 30-days of follow up.The primary outcome of the study was to compare the 30-day rates of ED-visits, readmissions, and complications between sPCNL and aPCNL. Secondary outcomes included: cost analysis and stone free rates (SFRs). Statistical analysis was performed using SPSSv26 using independent t-tests for continuous variables and chi-square analyses for categorical varaibles. RESULTS: We found no difference in 30-day ED-visits, readmissions, or complications between the two groups. aPCNL resulted in cost savings of $5689±237 per case, a 29.6% reduction. CONCLUSIONS: aPCNL appears safe to perform and does not have a higher rate of ED-visits or readmissions compare to sPCNL. aPCNL also is also cost-effective compared to sPCNL. Patients undergoing same-day discharge were not at higher risk of ED-visits or readmission to the hospital.