PCNL use rising, and so are related complications

Increased use of percutaneous nephrolithotomy (PCNL) in recent years coincides with a rising rate of complications related to the surgery, according to a published study by researchers from Henry Ford Hospital, Detroit.

The study also found that women now constitute the majority of patients undergoing PCNL in the United States.

"What we found is that the use of PCNL in this country has increased, and more women than men have the procedure," said first author Khurshid R. Ghani, MD, of Henry Ford Hospital’s Vattikuti Urology Institute. "We also discovered that while the rate of PCNL-related death is low and has remained so, incidence of blood infection and overall complications has increased."

The research appears online in the Journal of Urology (Feb. 19, 2013).

The population-based study looked at data from the Nationwide Inpatient Sample, which catalogs some eight million cases from more than 1,000 hospitals in 44 states. It was used to identify patients who underwent PCNL between 1999 and 2009. A weighted sample was then formulated to estimate utilization rates across the country.

The Henry Ford researchers also tracked and analyzed trends in patient age; complications before, during and after the procedure; comorbid conditions at the time of the surgery; and in-hospital deaths.

A total of 80,097 patients over the age of 18 years (median age, 53 years) were found to have undergone PCNL during the study period, during which the number of times the procedure was performed climbed by 47%.

PCNL use rose from 3.0 to 3.63 per 100,000 men, and from 2.99 to 4.07 per 100,000 women during the study period. This represented a 0.03% increase in men who underwent the procedure versus a 2.54% increase in women.

Comorbidity increased during the course of the study. At the same time, overall complications increased from 12.2% in 1999 to 15.6% in 2009. In particular, the incidence of sepsis doubled, rising from 1.2% to 2.4%.

The rate of PCNL-related death remained essentially unchanged at 0 to 0.4%.

Dr. Ghani and colleagues concluded that patients were at higher risk of developing complications if they were older, sicker, and treated in more recent years. Although the rate of deaths associated with the procedure remained statistically flat, those cases that did occur were found with older patients.