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Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index
Ali Unsal1, Berkan Resorlu, Ali Fuat Atmaca
1Kecioren Training and Research Hospital, Department of Urology, and Hacettepe University, Faculty of Science, Department of Statistics, Ankara, Turkey.
Insights
The Charlson Comorbidity Index (CCI) effectively predicts medical complications and mortality after percutaneous nephrolithotomy (PCNL). Higher CCI scores correlate with increased risk, aiding in patient stratification for this kidney stone procedure.
Area of Science:
- Urology
- Nephrology
- Surgical Outcomes
Background:
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.
- Patient comorbidities can influence surgical outcomes.
- Predictive tools are needed to assess risks associated with PCNL.
Purpose of the Study:
- To evaluate the Charlson Comorbidity Index (CCI) as a predictor of postoperative medical complications and mortality.
- To determine if CCI can stratify risk in patients undergoing PCNL.
Main Methods:
- A multicenter retrospective review of 1406 PCNL procedures.
- Data collected included patient demographics, stone characteristics, comorbidities, operative details, and postoperative outcomes.
- Patients were stratified into groups based on CCI scores (0, 1, ≥2).
Main Results:
- Higher CCI scores were associated with an increased incidence of comorbidities.
- The rate of life-threatening medical complications significantly increased with higher CCI scores (2.9% for CCI 0, 7.6% for CCI 1, 21.6% for CCI ≥2).
- CCI score, patient age, hemorrhage, and operative time were significant predictors of medical complications.
Conclusions:
- The Charlson Comorbidity Index (CCI) is a valuable tool for predicting morbidity and mortality in PCNL patients.
- CCI offers a simple, reproducible method for risk assessment.
- Utilizing CCI can aid in optimizing patient selection and perioperative management for PCNL.
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.
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