WCE 2017: Contemporary Trends in Utilization and Outcomes Of Percutaneous Nephrolithotomy in the United States From 2003 to 2014
PCNL is the recommended first-line treatment for patients with large stone burden (> 20mm). However, contemporary data has demonstrated that flexible ureteroscopy (URS) is increasingly challenging PCNL in the treatment of medium to large sized kidney stones.
Dr. Harmouch’s group sought to analyze the current trends in the rates and outcomes of PCNL. They used the Premier Healthcare Database and identified 225,321 patients diagnosed with kidney/ureter calculus who underwent PCNL at 447 different hospitals across the United States. They recorded 90-day postoperative, prolonged hospital length of stay, operating room time, blood transfusions and direct hospital costs.
They found that PCNL rates increased from 2003-2008, then plateaued for 3 years until declining into 2014. However, overall/major complication and blood transfusion rates rose over this time period by 23.1%/4.8% and 3.3%, respectively. Significant predictors of overall complications were higher Charlson comorbidity index, whereas higher surgeon volume was significantly associated with decreased overall and major complications.
Dr. Harmouch concluded that the observed contemporary decrease in utilization of PCNL may be due to an increase in the use of flexible URS. This could have shifted the case load for PCNL to even more complex cases, thus giving rise to increased complication rates. However, it is important to note that numerous patient, hospital and surgical characteristics affect complication rates and may have implications on referral patterns and patient selection.
Presented by: Sabrina Harmouch, MD
Authors: Sabrina Harmouch, Jeffrey J. Leow, Christian P. Meyer, Ye Wang, Steven L. Chang, Benjamin I. Chung, Quoc Dien Trinh, Ruslan Korets, Naeem Bhojani, FRCSC
Affiliation: Division of Urology, Université de Montréal, Division of Urology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School Boston, Massachusetts, Department of Urology, Stanford University, Stanford, CA, Veterans Affairs Boston Healthcare System, Harvard Medical School Boston, Massachusetts
Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.