PD47-01 ASSESSING THE VOLUME-OUTCOME RELATIONSHIP FOR PCNL IN 2014- ANALYSIS USING UK NATIONAL REGISTRY DATA OF OVER 2000 CASES

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2016PD47-01 ASSESSING THE VOLUME-OUTCOME RELATIONSHIP FOR PCNL IN 2014- ANALYSIS USING UK NATIONAL REGISTRY DATA OF OVER 2000 CASES John Withington, William Finch, Sarah Fowler, James Armitage, Jonathan Glass, Stuart Irving, Neil Burgess, Kay Thomas, and Oliver Wiseman John WithingtonJohn Withington More articles by this author , William FinchWilliam Finch More articles by this author , Sarah FowlerSarah Fowler More articles by this author , James ArmitageJames Armitage More articles by this author , Jonathan GlassJonathan Glass More articles by this author , Stuart IrvingStuart Irving More articles by this author , Neil BurgessNeil Burgess More articles by this author , Kay ThomasKay Thomas More articles by this author , and Oliver WisemanOliver Wiseman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2689AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Volume-outcome studies in PCNL have reported mixed findings. In the UK, PCNL was previously shown to be equally safe in high and low volume hospitals; this study investigates the relationship between volume and stone clearance, adjusted for stone complexity. METHODS Data from the prospective British Association of Urological Surgeons PCNL registry in 2014 were analysed. Two groups were defined; hospitals performing fewer than 20 and those performing 20 or more cases per year. Comparisons performed between these groups included stone complexity and outcomes, including stone clearance at day one, blood transfusion, sepsis and median post-operative length of stay (LOS). Subgroups of complex (Guy’s Stone Score III-IV) and non-complex (GSS I-II) stones were also compared. RESULTS 2042 procedures were recorded in the registry in 2014. There was no significant difference between stone complexity (p=0.056), or stone dimensions (p=0.18) of cases undertaken at high and low volume centres. Overall stone clearance, by imaging at day 1, was higher in the high volume group than the low volume group (73% vs 63%, p<0.05). This was true for both complex and non-complex stones (55%vs 45%, p<0.05; 85% vs 77%, p<0.05). Blood transfusion rates did not differ significantly between high and low volume groups overall (2.5% vs 2.6%, p=0.92), or when subdivided by stone complexity (GSS III-IV: 3.0% vs 4.9%, p=0.22; GSS I-II, 0.9%vs 2.2%, p=0.09). Post-operative sepsis occurred in 3.1% patients overall. Hospital volume made no significant difference overall (p=0.1), in complex stones (p=0.09) or in non-complex stones (p=0.97). Overall, median total length of stay (LOS) was shorter at high volume centres than low volume centres (2d v 3d). For GSS I-II stones, LOS was shorter for high volume (2d v 3d); this difference was less for GSS III-IV (3.5d v 4d). CONCLUSIONS Hospital volume does not appear to significantly affect transfusion or sepsis rates post-PCNL; stone complexity seems to be more relevant to these outcomes. Stone clearance, however is clearly associated with hospital volume, higher volume centres achieving significantly higher stone free rates. These findings may inform the debate around centralisation of complex PCNL. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1170 Advertisement Copyright & Permissions© 2016MetricsAuthor Information John Withington More articles by this author William Finch More articles by this author Sarah Fowler More articles by this author James Armitage More articles by this author Jonathan Glass More articles by this author Stuart Irving More articles by this author Neil Burgess More articles by this author Kay Thomas More articles by this author Oliver Wiseman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...