1687 PERCUTANEOUS NEPHROLITHOTOMY IN ENGLAND: PRACTICE AND OUTCOMES DESCRIBED IN THE HOSPITAL EPISODE STATISTICS DATABASE

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II)1 Apr 20131687 PERCUTANEOUS NEPHROLITHOTOMY IN ENGLAND: PRACTICE AND OUTCOMES DESCRIBED IN THE HOSPITAL EPISODE STATISTICS DATABASE James Armitage, John Withington, Jan van der Meulen, David Cromwell, Jonathan Glass, William Finch, Stuart Irving, and Neil Burgess James ArmitageJames Armitage Cambridge, United Kingdom More articles by this author , John WithingtonJohn Withington London, United Kingdom More articles by this author , Jan van der MeulenJan van der Meulen London, United Kingdom More articles by this author , David CromwellDavid Cromwell London, United Kingdom More articles by this author , Jonathan GlassJonathan Glass London, United Kingdom More articles by this author , William FinchWilliam Finch Norwich, United Kingdom More articles by this author , Stuart IrvingStuart Irving Norwich, United Kingdom More articles by this author , and Neil BurgessNeil Burgess Norwich, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3049AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is an increasing need for complete and accurate data on surgical outcomes in the United Kingdom. We investigated whether the Hospital Episode Statistics (HES) database, which records details of all admissions to NHS hospitals in England, could be used to evaluate the outcomes of Percutaneous Nephrolithotomy (PCNL), an index complex endourological procedure. METHODS We extracted HES records for all patients undergoing PCNL in English NHS hospitals. Since 2006, PCNL has been recorded in HES using a single procedure code (M164). Where patients had more than one PCNL procedure, we only included their first (index) procedure in the analysis. Primary outcomes were haemorrhage, infection, and mortality within 30 days of surgery. Readmission rates and reasons for readmission were also investigated. RESULTS Between March 2006 and 31 January 2011, 6,118 index PCNL procedures were performed in 165 English NHS hospitals. Most patients were men (55%) and more had left-sided procedures (57%). The median length of stay was 4 days. Levels of activity varied across hospitals with 45 performing more than 50 procedures, and 10 more than 100 procedures. Haemorrhage was recorded in 87 patients (1.4%). 24 patients (0.4%) had angiography after PCNL and 21 (0.3%) had selective embolisation. 230 patients (3.8%) had a urinary tract infection during their admission for PCNL and 54 patients (0.9%) had sepsis. There were 17 in-hospital deaths (0.3%) recorded within 30 days of PCNL. More than one quarter of patients (1,625) were readmitted within 30 days of discharge. 951 patients were readmitted electively, for example, 311 for ureteric stent removal and 121 for lithotripsy or ureteroscopy. There were 674 emergency readmissions: 90 patients (1.5%) with urinary tract infection, 23 with sepsis (0.4%), 72 (1.2%) haematuria, 29 (0.5%) haemorrhage, and 33 (0.5%) with acute urinary retention. CONCLUSIONS The HES database provides a large contemporary dataset for PCNL in England. It does not provide detail on stone complexity or burden and cannot provide direct information on the effectiveness of treatment. Haemorrhage and infection represent relatively common and potentially severe complications of PCNL and can be identified in HES. 30-day in-hospital mortality is extremely rare after PCNL but appears to be reliably recorded in HES. Safety outcomes for PCNL according to HES need to be corroborated using other data sources, such as the BAUS PCNL data registry and prospective audit, if HES is to be used to evaluate the performance of urologists or healthcare providers in England. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e694 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Armitage Cambridge, United Kingdom More articles by this author John Withington London, United Kingdom More articles by this author Jan van der Meulen London, United Kingdom More articles by this author David Cromwell London, United Kingdom More articles by this author Jonathan Glass London, United Kingdom More articles by this author William Finch Norwich, United Kingdom More articles by this author Stuart Irving Norwich, United Kingdom More articles by this author Neil Burgess Norwich, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...