Ambulatory PCNL may be cost-effective compared to standard PCNL

ABSTRACT

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.