Hospital-Based Analysis of Trends and Outcomes for Patients Undergoing Pyelolithotomy.
OBJECTIVE
To determine trends in pyelolithotomy, evaluate risk factors for complications, and evaluate the difference in outcomes and charges between open and minimally invasive (MI) techniques.


PATIENTS AND METHODS
We used the Nationwide Inpatient Sample to identify patients with a diagnosis of having nephrolithiasis undergoing pyelolithotomy from 2008 to 2012. Total charges were inflation-adjusted to U.S. dollars in 2012. Patient demographics, hospital characteristics, and outcomes were reported and compared between open and MI groups after survey weighting.


RESULTS
We included a survey-weighted population of 17,294 patients, of whom 841 (4.9%) had MI pyelolithotomy. The proportion of MI cases increased by 2.57% annually (r2 = 0.921, p = 0.01), although total pyelolithotomy cases remained stable. Simultaneous pyeloplasty occurred in 6.6% of all patients. Patients receiving open surgery experienced longer length of stay (3.9 days vs 2.7 days; p < 0.001), but accrued equivalent inflation-adjusted charges ($49,588 ± 2088 vs $51,716 ± 4893; p = 0.665). On multivariable analysis, higher Elixhauser comorbidity index and presence of any genitourinary anomaly were associated with experiencing a complication, while undergoing surgery at a top quartile hospital and elective admission status were protective against complications. MI technique and simultaneous ureteropelvic junction repair did not alter complication risk.


CONCLUSION
While the annual number of pyelolithotomy cases was stable, there was an increasing trend toward MI technique. Both patient and hospital factors can significantly alter the risk for complications following pyelolithotomy.
['Nottingham|Charles U|CU|', 'Cohen|Andrew J|AJ|', 'Packiam|Vignesh T|VT|', 'Pariser|Joseph J|JJ|', 'Gerber|Glenn S|GS|']
D000368:Aged D017558:Elective Surgical Procedures D005260:Female D006801:Humans D007297:Inpatients D007669:Kidney Calculi D007682:Kidney Pelvis D007902:Length of Stay D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D011446:Prospective Studies D019651:Reconstructive Surgical Procedures D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D014481:United States D014513:Ureter
trends pyelolithotomy nephrolithiasis pyeloplasty renal calculus