Jeffrey J Leow1,2, Christian P Meyer1, Ye Wang1, Steven L Chang1, Benjamin I Chung3, Quoc Dien Trinh1, Ruslan Korets4, Naeem Bhojani5. 1. 1 Division of Urology and Center for Surgery and Public Health , Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 2. 2 Department of Urology, Tan Tock Seng Hospital , Singapore . 3. 3 Department of Urology, Stanford University , Stanford, California. 4. 4 Department of Urology, Veterans Affairs Boston Healthcare System, Harvard Medical School , Boston, Massachusetts. 5. 5 Department of Urology, Université de Montréal , Montréal, Quebec, Canada .
Abstract
PURPOSE: To investigate the contemporary trends and perioperative outcomes of percutaneous nephrolithotomy (PCNL) by using a population-based cohort. MATERIALS AND METHODS: Using the Premier Healthcare Database, we identified 225,321 patients in whom kidney/ureteral calculi were diagnosed and who underwent PCNL at 447 different hospitals across the United States from 2003 to 2014. Outcomes included 90-day postoperative complications (as classified by the Clavien-Dindo system), prolonged hospital length of stay, operating room time, blood transfusions, and direct hospital costs. Temporal trends were quantified by estimated annual percentage change (EAPC) by using least-squares linear regression analysis. Multivariable logistic regression was performed to identify predictors of outcomes. RESULTS: PCNL utilization rates initially increased from 6.7% (2003) to 8.9% (2008) (EAPC: +5.60%, p = 0.02), before plateauing at 9.0% (2008-2011), and finally declining to 7.2% in 2014 (EAPC: -4.37%, p = 0.02). Overall (Clavien ≥1) and major complication (Clavien ≥3) rates rose significantly (EAPC: +12.2% and +16.4%, respectively, both p < 0.001). Overall/major complication and blood transfusion rates were 23.1%/4.8% and 3.3%, respectively. Median operating room time and 90-day costs were 221 minutes (interquartile range [IQR] 4) and $12,734 (IQR $9419), respectively. Significant predictors of overall complications include higher Charlson comorbidity index (CCI) (CCI ≥2: odds ratio [OR] 2.08, p < 0.001) and more recent year of surgery (2007-2010: OR 3.20, 2011-2014: OR 4.39, both p < 0.001). Higher surgeon volume was significantly associated with decreased overall (OR 0.992, p < 0.001) and major (OR 0.991, p = 0.01) complications. CONCLUSIONS: Our contemporary analysis shows a decrease in the utilization of PCNL in recent years, along with an increase in complication rates. Numerous patient, hospital, and surgical characteristics affect complication rates.
PURPOSE: To investigate the contemporary trends and perioperative outcomes of percutaneous nephrolithotomy (PCNL) by using a population-based cohort. MATERIALS AND METHODS: Using the Premier Healthcare Database, we identified 225,321 patients in whom kidney/ureteral calculi were diagnosed and who underwent PCNL at 447 different hospitals across the United States from 2003 to 2014. Outcomes included 90-day postoperative complications (as classified by the Clavien-Dindo system), prolonged hospital length of stay, operating room time, blood transfusions, and direct hospital costs. Temporal trends were quantified by estimated annual percentage change (EAPC) by using least-squares linear regression analysis. Multivariable logistic regression was performed to identify predictors of outcomes. RESULTS: PCNL utilization rates initially increased from 6.7% (2003) to 8.9% (2008) (EAPC: +5.60%, p = 0.02), before plateauing at 9.0% (2008-2011), and finally declining to 7.2% in 2014 (EAPC: -4.37%, p = 0.02). Overall (Clavien ≥1) and major complication (Clavien ≥3) rates rose significantly (EAPC: +12.2% and +16.4%, respectively, both p < 0.001). Overall/major complication and blood transfusion rates were 23.1%/4.8% and 3.3%, respectively. Median operating room time and 90-day costs were 221 minutes (interquartile range [IQR] 4) and $12,734 (IQR $9419), respectively. Significant predictors of overall complications include higher Charlson comorbidity index (CCI) (CCI ≥2: odds ratio [OR] 2.08, p < 0.001) and more recent year of surgery (2007-2010: OR 3.20, 2011-2014: OR 4.39, both p < 0.001). Higher surgeon volume was significantly associated with decreased overall (OR 0.992, p < 0.001) and major (OR 0.991, p = 0.01) complications. CONCLUSIONS: Our contemporary analysis shows a decrease in the utilization of PCNL in recent years, along with an increase in complication rates. Numerous patient, hospital, and surgical characteristics affect complication rates.
Authors: Jennifer Bjazevic; Linda Nott; Philippe D Violette; Thomas Tailly; Marie Dion; John D Denstedt; Hassan Razvi Journal: Can Urol Assoc J Date: 2019-10 Impact factor: 1.862
Authors: Neel H Patel; Suraj S Parikh; Jonathan B Bloom; Ariel Schulman; Jonathan Wagmaister; Sean Fullerton; John L Phillips; Muhammad Choudhury; Majid Eshghi Journal: J Endourol Date: 2019-07-23 Impact factor: 2.942
Authors: Jeffrey J Leow; Anne-Sophie Valiquette; Benjamin I Chung; Steven L Chang; Quoc-Dien Trinh; Rus Korets; Naeem Bhojani Journal: Can Urol Assoc J Date: 2018-06-19 Impact factor: 1.862
Authors: Sabrina S Harmouch; Hiba Abou-Haidar; Hassan Elhawary; Thomas Grgic; Andrea G Lantz; Jason Y Lee; Ben H Chew; Sero Andonian; Naeem Bhojani Journal: Can Urol Assoc J Date: 2018-05-28 Impact factor: 1.862