Outpatient ureteroscopy: predictive factors for postoperative events.

摘要

OBJECTIVES: To identify risk factors that can predict the postoperative events of outpatient ureteroscopy. METHODS: The data of 329 consecutive patients who underwent outpatient ureteroscopy from January 1996 to July 2000 were analyzed. Patient selection for outpatient surgery was based solely on their general medical status and social factors. Eighty-three percent of the procedures were therapeutic ureteroscopy. The reported postoperative events included sleep disturbances, postoperative pain score, emesis, unplanned admission, and other complications. These were compared with the various patient and operative factors. Multivariate analysis was performed to identify the predictive factors for different postoperative events. RESULTS: The overall success rate of ureteroscopic access to the pathologic site was 99.7%. Most of the therapeutic ureteroscopy performed was ureteroscopic lithotripsy (93%), with a stone-free rate of 91%. Ninety-seven percent of the operations were completed within 90 minutes, and 98% of patients were fit for discharge within 5 hours. Female patients reported more symptoms on the way home (25.8% versus 16%, P = 0.047) and more postoperative emesis (14.4% versus 2.1%, P <0.001). The postoperative pain score on day 1 was higher if the operation had lasted more than 60 minutes (2.4 versus 1.5, P = 0.002). Patients who received postoperative stenting had a higher postoperative pain score on day 3 (1.1 versus 0.4, P <0.001) and a higher complication rate compared with those who required no postoperative stenting (16.8% versus 4%, P <0.001). No predictive factors for unplanned admission were identified. CONCLUSIONS: Ureteroscopy can be successfully performed in an outpatient setting. Although the early postoperative pain was associated with nature of the operation (which could not be changed), the subsequent postoperative pain and complications were associated with ureteral stenting, which could be reduced by selective stenting. Unplanned admissions could not be predicted.