Contemporary Trends In Utilization And Perioperative Outcomes Of Percutaneous Nephrolithotomy In The United States From 2003 To 2014.

Abstract

To investigate contemporary trends and perioperative outcomes of PCNL using a population-based cohort.Using the Premier Healthcare Database, we identified 225,321 patients diagnosed with kidney/ureter calculus 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 percent change (EAPC) using least squares linear regression analysis. Multivariable logistic regression was performed to identify predictors of outcomes.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), then 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 mins (IQR 4) and $12734 (IQR $9419), respectively. Significant predictors of overall complications include higher Charlson comorbidity index (CCI) (CCI=2: 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.Our contemporary analysis shows a decrease in utilization of PCNL in recent years, along with an increase in complication rates. Numerous patient, hospital and surgical characteristics affect complication rates.

View details for DOI 10.1089/end.2017.0225

View details for PubMedID 28557565