A Multicenter Randomized Controlled Trial of Ambulatory Versus Inpatient Percutaneous Nephrolithotomy
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVE: Ambulatory percutaneous nephrolithotomy (PCNL) has been proposed as a means to speed patient recovery and decrease cost compared with inpatient PCNL. The objective of our study was to perform a high-quality randomized controlled trial of ambulatory versus inpatient PCNL. METHODS: A multicenter noninferiority randomized controlled trial of ambulatory versus inpatient PCNL was conducted at Health Sciences Centre Winnipeg, and University of California, San Francisco Medical Center. Patients were randomized prior to surgery, stratified based on American Society of Anesthesiologists (ASA) status, body mass index (BMI), stone size, and study site. The primary outcome was complication rates within 4 wk of surgery. KEY FINDINGS AND LIMITATIONS: Of 70 patients (35 ambulatory and 35 inpatient), 48% had BMI >30, 41% had ASA 3/4, and 31% had stone size >4 cm. Complication rates were 6% in the ambulatory and 14% in the inpatient group (risk difference -8%, 95% confidence interval [CI] -22% to 5%, p = 0.4). The readmission rate was 6% in the ambulatory versus 3% in the inpatient group (risk difference 3%, 95% CI -7% to 12%, p = 0.6). The stone-free rate was 77% in the ambulatory versus 71% in the inpatient group (risk difference -6%, 95% CI -27% to 15%, p = 0.6). In a multivariable analysis, we did not see evidence of inferiority of ambulatory PCNL compared with inpatient PCNL for complications (odds ratio [OR] 0.49, 95% CI 0.12-1.94, p = 0.3) or residual stone fragments (OR 1.46, 95% CI 0.44-5, p = 0.5). Limitations include a somewhat low sample size. CONCLUSIONS AND CLINICAL IMPLICATIONS: We did not see evidence of inferiority of ambulatory PCNL compared with inpatient PCNL for complication rates, stone-free rates, readmission rates, or quality of life. Our results support the use of ambulatory PCNL at experienced centers.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".