Factors determining perioperative complications of percutaneous nephrolithotomy: A single center perspective

Abstract

ObjectiveTo determine factors affecting perioperative complications of percutaneous nephrolithotomy (PCNL) at a tertiary care academic center. Patients and methodsData from medical records of all patients who had undergone PCNL and matched the selection criteria in a tertiary care center between March 2010 and March 2015 were retrospectively reviewed. The demographic data, stone parameters, and stone free rate were addressed. Factors affecting perioperative complications of PCNL were evaluated and classified according to the modified Clavien classification (MCC) using different statistical methods. ResultsA total of 518 patients undergoing 575 PCNL procedures were enrolled in this study. Complications were detected in 148 patients (28.6%); the most serious complication was peri-operative bleeding in 53 patients (10.2%), which required conversion to open surgery in 12 cases (2.3%). Mortality occurred in 2 patients (0.4%). Grade I, II, IIIa, IIIb, IVa, IVb, V complications represented (14.1%), (15.4%), (7.5%), (2.3%), (0.6%), (0%), (0.4%), respectively. Complications of PCNL were significantly associated with tract numbers, tract location, method of stone extraction, and surgeon experience (P<0.05), while gender, stone shape and location, stone burden, degree of hydronephrosis, pervious surgery, position of PCNL (supine vs. prone) and comorbidity did not impact perioperative complications (P>0.05). ConclusionPerioperative complications of PCNL were significantly affected by surgeon experience, number of PCNL tracts, accessed calyx as well as method of stone extraction. However, patient gender, stone characteristics (configuration, location and burden), degree of hydronephrosis, pervious renal surgery, surgical position (supine vs. prone) did not impact the outcome of PCNL.