Percutaneous nephrolithotomy use is increasing in the United States: an analysis of trends and complications

Abstract

Purpose: To report the use and complication rates of percutaneous nephrolithotomy (PCNL) performed in the United States between 1998 and 2009.

Patients and methods: The Nationwide Inpatient Sample database was analyzed from 1998 to 2009 to identify all PCNL cases performed in adults ≥18 years old. Descriptive statistics were used for potential covariates: Demographics, comorbidities, academic/community hospital, rural/urban location, and U.S. geographic region. Common complications encoded by International Classification of Diseases-9 codes after PCNL were reported over time, and those found to be statistically significant were evaluated in the multivariate regression. Linear regression was used to analyze surgical trends. Multivariate regression was performed to identify covariates that predicted any surgical complication.

Results: The use of PCNL among inpatients increased significantly from 15 to 27 surgeries/100,000 discharges between 1998 and 2009 (P<0.001), and this increase was seen in all geographic regions of the United States. The increase in adoption of PCNL was accompanied by an increase in complications (14% to 19%, P<0.001). Higher comorbidity (Charlson ≥3) was the strongest predictor of complications in multivariate analysis (odds ratio=2.22, P<0.001).

Conclusions: This is the first study to demonstrate an increase in PCNL use in the United States over the last decade. While there was an increase in surgical complications during this same period, the complication rate found reported is commensurate with other international reports. PCNL is safe and use of percutaneous surgery in the United States will most likely continue to increase.