AUA 2017: Percutaneous Access Obtained by Urologist is Associated with Decreased Complications, Shorter Length of Stay and Lower Hospital Costs in Percutaneous Nephrolithotomy

Boston, MA ( Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure used for the removal of kidney stones. Interventional radiologists or urologists can both obtain renal access (RA) prior to PCNL. This study investigates the impact of physician specialty obtaining access on perioperative outcomes, complications, and costs of PCNL.

PCNL data was obtained from the Premier Hospital Database, a nationally representative hospital discharge database. A multivariable regression model was used to adjust for potential confounders.

This study identified a total of 19,985 patients undergoing PCNL between 2003-2015. There was 18.5% access to cases by urologists. RA were performed by high-volume surgeons performed (37% vs. 9.8% p<0.001) and hospitals with <400 beds (19.1% vs 17.9% p=0.04). There was an association between RA performed by a urologist and lower 90-day complication rate (16.9% vs 18.8% p1⁄40.008) and lower rates of prolonged hospitalization >2 days (31.6% vs 68.4%, p<0.001). Multivariable analysis showed an association between RA performed by a urologist and lower rates of complication (Clavien 1-5), shorter hospitalization (<2 days) and lower direct admission costs (<$12,515).

Although high-volume urologists are more likely to obtain their own RA, in the U.S., percutaneous access before PCNL is performed by a urologist minority of the time. This study concluded that RA by a urologist is associated with lower overall complications, shorter hospitalizations, and lower direct hospital costs.

Presented By: Ruslan Korets

Authors: Ruslan Korets*, Jacqueline M Speed, Ye Wang, Steven L Chang, Boston, MA

Affiliation: New York, NY

Written By: Rita Derderian, University of California, Irvine for

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA