Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index

Urology. 2012 Jan;79(1):55-60. doi: 10.1016/j.urology.2011.06.038.

Abstract

Objectives: To determine whether the Charlson Comorbidity Index (CCI) predicts postoperative medical complications and death in patients treated with percutaneous nephrolithotomy (PCNL).

Methods: A total of 1406 PCNL procedures were performed at 4-stone referral centers between September 2004 and March 2011 were reviewed in this multicenter study. Variables included patient and stone characteristics, preoperative comorbidities, intraoperative data, and postoperative complications, including mortality.

Results: The present study included 868 (61.7%) men and 538 (38.3%) women. Mean patient age was 44.1 years (range 1-81). CCI score was calculated as "0" for 993 patients (70.6%, called group I), "1" for 316 patients (22.5%, called group II) and"≥2" for 97 patients (6.9%, called group III). The incidence of comorbidities increased with age (P=.001). The overall postoperative complication rate was 29.3%. Life-threatening medical complications developed in 2.9% of patients in group I, 7.6% of patients in group II, and 21.6% of patients in group III, (P=.001). There were 3 deaths for an overall 0.2% mortality rate. Perioperative bleeding requiring blood transfusion was observed in 9.5% of patients, and we found an increased risk of hemorrhage associated with CCI score (P=.049). High CCI score, patient age, hemorrhage, and operative time were significantly related to higher medical complication rates after PCNL.

Conclusions: CCI is a quick, simple, and reproducible scoring system that accurately predicts the morbidity and mortality of PCNL.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Cause of Death*
  • Cohort Studies
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Minimally Invasive Surgical Procedures / mortality
  • Nephrolithiasis / diagnosis
  • Nephrolithiasis / surgery*
  • Nephrostomy, Percutaneous / adverse effects*
  • Nephrostomy, Percutaneous / methods
  • Odds Ratio
  • Postoperative Complications / mortality*
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Survival Analysis
  • Young Adult