David A Leavitt1, Piruz Motamedinia2, Shamus Moran3, Michael Siev3, Philip T Zhao3, Nithin Theckumparampil3, Mathew Fakhoury3, Sammy Elsamra4, David Hoenig3, Arthur Smith3, Zeph Okeke3. 1. Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York; Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan. Electronic address: david.a.leavitt@gmail.com. 2. Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York; Department of Urology, Yale University, New Haven, Connecticut. 3. Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York. 4. Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York; Rutgers Cancer Institute, New Brunswick, New Jersey.
Abstract
PURPOSE: Activities of daily living provide information about the functional status of an individual and can predict postoperative complications after general and oncological surgery. However, they have rarely been applied to urology. We evaluated whether deficits in activities of daily living could predict complications after percutaneous nephrolithotomy and how this compares with the Charlson comorbidity index and the ASA(®) (American Society of Anesthesiologists(®)) classification. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients who underwent percutaneous nephrolithotomy between March 2013 and March 2014. Those with complete assessment of activities of daily living were included in analysis. Perioperative outcomes, complications and hospital length of stay were examined according to the degree of deficits in daily living activities. RESULTS: Overall 176 patients underwent a total of 192 percutaneous nephrolithotomies. Deficits in activities of daily living were seen in 16% of patients, including minor in 9% and major in 7%. Complications developed more frequently in those with vs without deficits in daily living activities (53% vs 31%, p = 0.029) and length of stay was longer (2.0 vs 4.5 days, p = 0.005). On multivariate logistic regression activities of daily living were an independent predictor of complications (OR 1.11, p = 0.01) but ASA classification and Charlson comorbidity index were not. CONCLUSIONS: Activities of daily living are easily evaluated prior to surgery. They independently predict complications following percutaneous nephrolithotomy better than the Charlson comorbidity index or the ASA classification. Preoperative assessment of daily living activities can help risk stratify patients and may inform treatment decisions.
PURPOSE: Activities of daily living provide information about the functional status of an individual and can predict postoperative complications after general and oncological surgery. However, they have rarely been applied to urology. We evaluated whether deficits in activities of daily living could predict complications after percutaneous nephrolithotomy and how this compares with the Charlson comorbidity index and the ASA(®) (American Society of Anesthesiologists(®)) classification. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients who underwent percutaneous nephrolithotomy between March 2013 and March 2014. Those with complete assessment of activities of daily living were included in analysis. Perioperative outcomes, complications and hospital length of stay were examined according to the degree of deficits in daily living activities. RESULTS: Overall 176 patients underwent a total of 192 percutaneous nephrolithotomies. Deficits in activities of daily living were seen in 16% of patients, including minor in 9% and major in 7%. Complications developed more frequently in those with vs without deficits in daily living activities (53% vs 31%, p = 0.029) and length of stay was longer (2.0 vs 4.5 days, p = 0.005). On multivariate logistic regression activities of daily living were an independent predictor of complications (OR 1.11, p = 0.01) but ASA classification and Charlson comorbidity index were not. CONCLUSIONS: Activities of daily living are easily evaluated prior to surgery. They independently predict complications following percutaneous nephrolithotomy better than the Charlson comorbidity index or the ASA classification. Preoperative assessment of daily living activities can help risk stratify patients and may inform treatment decisions.
Authors: Vivek Venkatramani; Isildinha M Reis; Mark L Gonzalgo; Erik P Castle; Michael E Woods; Robert S Svatek; Alon Z Weizer; Badrinath R Konety; Mathew Tollefson; Tracey L Krupski; Norm D Smith; Ahmad Shabsigh; Daniel A Barocas; Marcus L Quek; Atreya Dash; Dipen J Parekh Journal: JAMA Netw Open Date: 2022-02-01