| Objective:To explore the feasibility and risk factors of delayed discharge of flexible ureteroscopic lithotripsy under day surgery.Methods:A retrospective analysis was made of 157patients with renal calculi who underwent flexible ureteroscopic holmium laser lithotripsy in the Department of Urology of the second affiliated Hospital of Kunming Medical University from January 2019 to January 2020,including 68 cases of day surgery and 89 cases of hospitalization.The age,sex,BMI,ASA grade,waiting time,longest stone diameter,stone density,preoperative urine culture results,stone location,preoperative indwelling double J tube,operation duration,intraoperative use of UAS,hospitalization cost,hospital stay and stone clearance rate one month after operation were compared between the two groups(stonefreerate).SFR),postoperative double J tube indwelling time,postoperative complications,unplanned readmission and other related conditions,all data were statistically analyzed by SPSS20.0,t-test was used to analyze the measurement data in accordance with normal distribution,and Mann-whitneyU rank sum test was used to analyze non-parametric data.Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of postoperative complications,and pearson correlation analysis was used to analyze the relationship between the length of operation and the longest diameter and density of calculi.Results:There was no significant difference in age,sex,BMI,ASA grade,longest stone diameter,stone density,preoperative urine culture,stone location,preoperative indwelling double J tube,operation duration,intraoperative sheath placement,postoperative SFR one month after operation,postoperative double J tube indwelling time and postoperative complications between day surgery group and inpatient operation group.The hospitalization cost,hospitalization time and waiting time in the day surgery group were significantly lower than those in the inpatient operation group(P<0.05).The postoperative complications were closely related to the longest diameter of stone,the length of operation,ASA grade,sheath placement during operation,urine culture before operation and indwelling double J tube before operation.In the day surgery group,the hospitalization time≤24 hours and>24 hours were divided into 24 hours discharge group and delayed discharge group.There were significant differences in the longest diameter of stone,the length of operation,the successful placement of sheath during operation and the postoperative complications between the two groups(P<0.05).The longest stone diameter(14.65±5.16mm vs 11.15 ±3.54 mm),the length of operation(75.58 ± 16.79min)and the incidence of postoperative complications(9.1%vs 69.2%)in the delayed discharge group were significantly higher than those in the 24-hour discharge group,while the intraoperative successful sheath placement rate(7%vs 47%)was significantly lower than that in the 24-hour discharge group,another 4 patients in the delayed discharge group were caused by social factors.In addition,there was a positive correlation between the length of operation and the longest stone diameter(r=0.319,P<0.05)and stone density(r=0.683,P<0.05)in the day surgery group.Conclusions:1.flexible ureteroscopic lithotripsy under day surgery operation mode is safe and feasible.Ureteroscopic lithotripsy according to the indication of day surgery can achieve the same therapeutic effect without increasing the risk of complications.2.The day surgery operation mode can significantly reduce the hospitalization expenses of patients,save medical costs,and effectively improve the utilization rate of hospital beds,which is an effective model to alleviate the imbalance between medical supply and demand in our country.3.Postoperative complications are the main reason for delayed discharge from hospital.Through effective prediction and control,the management of the daytime operation mode can be more efficient. |
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