Advancements in Performance of Percutaneous Nephrolithotomy in Ambulatory Surgery Centers: Outcomes and Lessons From 1250+ Cases

OBJECTIVE

To evaluate the safety and efficacy of routine ambulatory percutaneous nephrolithotomy (PCNL) in a freestanding ambulatory surgical center.

METHODS

Patients were treated between 2015 and 2022 by one of three experienced endourologists in Maryland. The surgery center is free-standing, with the nearest hospital approximately 10 minutes away. Patient characteristics and surgical datapoints, including need for transfer, were gathered prospectively at the time of surgery. Subset analyses were performed in patients with staghorn calculi or elevated body mass index, as they represent higher-risk populations.

RESULTS

A total of 1267 patients underwent ambulatory PCNL with a median stone diameter of 32 mm. The average recovery time was 87 minutes, with 1.7% of patients requiring transfer to the hospital, generally for postoperative hypotension or inadequate pain control. 166 patients with body mass index >40 were safely treated, with no significant difference in transfer rate (P = .5). 2.8% of patients had a complication, with the majority being Clavien-Dindo grade I or II. 88 patients with staghorn calculi were treated, with a 6% transfer rate. Staghorn calculi were the only factor found on multivariable analysis to be a significant predictor of transfer (OR 3.56 (1.17-10.82) P < .05).

CONCLUSION

Ambulatory PCNL may safely be performed in a surgery center in most patients. These outcomes reflect the real-world experience of high-volume surgeons and demonstrate a multiyear paradigm shift in PCNL from an inpatient procedure to an outpatient procedure in a surgery center.

Twitter mentions and academic citations in the urologic oncology literature

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Background: Social media use has dramatically increased in academic medicine with over 70% of journals now using twitter accounts. This calls into question if there is a measurable association between academic impact and Twitter use. We sought to quantify the relationship between the number of Twitter mentions and the number of academic citations a urologic oncology publication receives. Methods: 210 papers from 7 prominent urology journals were examined 18 months after publication from December 2014-January 2015. Articles were evaluated with 2 citation based “bibliometrics” (Scopus, Google Scholar) and 1 social media based metric (Altmetric). Altmetric software allowed for individual tweets regarding an article to be examined. Scores and Twitter mentions for oncology and non-oncology publications were compared using ANOVA and contingency analysis. Results: 79 articles were oncology related while 131 pertained to other topics. The mean number of Twitter mentions for oncology articles was 4.1, compared to 2.4 for non-oncology articles (p=0.004). Articles with at least one twitter mention had 2.0 fold more Scopus citations (p<0.01), 2.1 fold more Google Scholar citations (p<0.01), and 27.8 fold higher Altmetric scores (p<0.001). Oncology authors tended to be more active on Twitter, with 13.9% of oncology authors self-tweeting their own articles versus 5.3% of non-oncology authors (p=0.04). Authors self-tweeting oncology articles was associated with an increased number of citations, with a 10.3 and 7.9 mean citation increase in Google Scholar and Scopus scores (p=0.04 and p=0.01) compared to non-self-tweeted oncology articles. (See table.) Conclusions: Social media appears to be more prominent in the urologic oncology community. The number of citations a urologic oncology publication receives is associated with the number of mentions it has on Twitter. Authors self-tweeting articles may be a factor that increases paper visibility and academic impact. [Table: see text]