Comparison of staff workload between percutaneous nephrolithotomy with and without intraoperative cone-beam CT: an 18-month postoperative analysis.

Abstract

To assess whether hybrid cone-beam computed tomography (CBCT)-percutaneous nephrolithotomy (PCNL) reduces overall staff demands compared to standard PCNL. We performed a retrospective study of a randomised controlled trial conducted in a tertiary Dutch urolithiasis centre. A total of 160 patients were randomised 1:1 to CBCT-PCNL or standard PCNL. Staff time was estimated from preoperative assessment through 18 months of follow-up, including both elective and unplanned care delivered by nurses, urologists, anaesthesiologists, intensivists, radiologists, and technical staff. Time estimates were derived from literature, standard times, and bottom-up and top-down calculations. Hybrid CBCT-PCNL required 36.3 staff hours per patient vs 43.1 h for standard PCNL (19% reduction), largely driven by a 47% decrease in unplanned care due to fewer complications and stone-related events. Most care was attributable to nurses (61% in the CBCT-PCNL group; 63% in the standard PCNL group), with time concentrated in hospital days (43%; 42%) and surgery (46%; 38%). Hybrid CBCT-PCNL can improve clinical efficiency and reduce labour demand, freeing staff for other care needs. These findings highlight how innovative urological technologies can enhance care efficiency, which is especially important amid growing workforce pressures.