MP30-16 PROGNOSTIC FACTORS OF POSTOPERATIVE COMPLICATIONS IN PERCUTANEOUS NEPHROLITHOTOMY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2015MP30-16 PROGNOSTIC FACTORS OF POSTOPERATIVE COMPLICATIONS IN PERCUTANEOUS NEPHROLITHOTOMY Fabio C. Vicentini, Carlos H. Watanabe-Silva, Vinicius Meneguete, Rodrigo Perrela, Claudio B. Murta, and Joaquim F.A. Claro Fabio C. VicentiniFabio C. Vicentini More articles by this author , Carlos H. Watanabe-SilvaCarlos H. Watanabe-Silva More articles by this author , Vinicius MenegueteVinicius Meneguete More articles by this author , Rodrigo PerrelaRodrigo Perrela More articles by this author , Claudio B. MurtaClaudio B. Murta More articles by this author , and Joaquim F.A. ClaroJoaquim F.A. Claro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.598AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large kidney stones but there are concerns regarding the complication rates. Our aim is to evaluate the peri-operatory factors associated with complications after PCNL. METHODS We performed a retrospective chart review of a prospective database of patients who underwent PCNL between July 2011 and July 2014. Preoperative and postoperative factors, such as age, body mass index (BMI), surgical risk, stone complexity (Guy's Stone Score - GSS), access calyx, patient positioning, blood transfusion and surgical time were evaluated as predictors of complications. All complications were graded according to the Clavien Classification. The tests used in the univariate analyzes were chi-square and Fisher Exact test for categorical measures and the Student t test for continuous measures. For the multivariate analysis we used logistic regression. RESULTS A total of 468 patients were included in the study and 517 PCNL were performed. The mean age was 48.3±12.8 years, mean BMI of 27.3±5.0 and 57.8% were female. Of these, 82% underwent to PCNL in supine position and 18% in the prone position. According to GGS, 24.8% were GGS1, 28.6% GSS2, 33.8% GSS3 and GSS4 12.8%. Most punctures were on lower and middle calyx (65.8% and 24.8% respectively) and 9.3% of the punctures were supracostal. Mean surgical time 114.6±52.78 min. The success rate (fragments ≤4mm) at POD 1 on CT scan was 55.1% The overall complication rate was 18.7%. According to the modified Clavien Classification System, 5.3% Clavien I, 6.7% Clavien II, 2.0% Clavien IIIa, 2.3% Clavien IIIB, 1.6% Clavien IVa, 0.4% Clavien IVB and 0.4% Clavien V. The transfusion rate was 6.0%. On univariate analysis, the number of accesses, supracostal puncture, upper calyx puncture and higher GSS were predictors of Clavien≥3 (major complications). On multivariate analysis, GSS and upper calyx puncture were the only predictors statistically significant for post-operative complications Clavien ≥3. GSS III and IV increased risk for high grade Clavien compared to GSS I and II (OR 2.52; CI95% 1.21-5.52) and also upper pole access compared to inferior pole access (OR 4.85; CI95%1.46-13.92). Moreover, prone position (OR 2.53; CI95%1.0-6.08), number of punctures (OR 6.11 CI95%1.58-24.04) and high GSS (OR3.01 CI1.19-8.6) were associated with blood transfusions on multivariate analysis. CONCLUSIONS The number of punctures, supracostal access, high GSS and prone position were factors associated with major complications and blood transfusions after PCNL. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e353 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabio C. Vicentini More articles by this author Carlos H. Watanabe-Silva More articles by this author Vinicius Meneguete More articles by this author Rodrigo Perrela More articles by this author Claudio B. Murta More articles by this author Joaquim F.A. Claro More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...