Prediction of Morbidity and Mortality After Percutaneous Nephrolithotomy By Using the Charlson Comorbidity Index

• Published in: Urology (Ridgewood, N.J.) N.J.), 2012, Vol.79 (1), p.55-60
• Main Authors: Unsal, Ali, Resorlu, Berkan, Atmaca, Ali Fuat, Diri, Akif, Goktug, Hasan Nedim Goksel, Can, Ceren Eda, Gok, Bahri, Tuygun, Can, Germiyonoglu, Cankon
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Cause of Death; Cohort Studies; Female; Hospital Mortality - trends; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Nephrolithiasis - diagnosis; Nephrolithiasis - surgery; Nephrology. Urinary tract diseases; 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; Urology; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2011.06.038

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.