title: Ambulatory percutaneous nephrolithotomy: what is the rate of readmission?
abstract: OBJECTIVE
  Tubeless percutaneous nephrolithotomy (PCNL) has gained popularity in an attempt to decrease morbidity and accelerate discharge. Recently, ambulatory tubeless PCNL has been reported. There are no data, however, regarding readmission rates of patients who had ambulatory PCNL. Therefore, the aim of this study was to assess rates of emergency department (ED) visits and readmissions postambulatory PCNL.
  
  
  METHODS
  A retrospective chart review of all ambulatory PCNL cases at two institutions between March 2007 and December 2013 was performed. Preoperative, intraoperative, and postoperative data were collected including the amount of narcotics used, length of hospital stay, postoperative complications, returns to the ED, and readmissions.
  
  
  RESULTS
  Fifty patients underwent ambulatory PCNL, including two bilateral cases, making up a total of 52 renal units. All patients were discharged home on the same day with a mean hospital stay of 208.32±73.43 minutes. The mean narcotic requirement was 41.13±46.76 mg of oral morphine equivalents. Six patients (12%) returned to the ED, all within 7 days. Four of these 6 patients were discharged; three with stent colic and one with wound cellulitis. Only two (4%) patients were readmitted-one with multiresistant Escherichia coli and one with uncomplicated stent colic. Overall stone-free rate was 90.4%. There were no major complications, while low grade (I-II) Clavien complications developed in 9 (18%) patients.
  
  
  CONCLUSIONS
  Ambulatory PCNL is safe in highly selected patients with a stone-free rate of 90% and readmission rate of 4%. Prospective studies comparing standard PCNL with ambulatory PCNL are warranted.
authors.affiliation: 1 Department of Urology, Queen's University , Kingston, Canada .
authors.forename: Darren
authors.initials: D
authors.lastname: Beiko
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.forename: Andrea
authors.initials: A
authors.lastname: Kokorovic
authors.forename: Gregory
authors.initials: G
authors.lastname: Roberts
authors.forename: Sylvia
authors.initials: S
authors.lastname: Robb
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult
chemical_list: D009294:Narcotics