Morris David S, Wei John T, Taub David A, Dunn Rodney L, Wolf J Stuart, Hollenbeck Brent K
Department of Urology and Division of Clinical Research and Quality Assurance, University of Michigan, Ann Arbor, Michigan, USA.
J Urol. 2006 May;175(5):1731-6. doi: 10.1016/S0022-5347(05)00994-8.
Treatment for nephrolithiasis has evolved because of the dissemination of less invasive techniques, such as ureteroscopy and shock wave lithotripsy. We examined temporal trends in PCNL use and characterized the determinants of a prolonged LOS and in-hospital mortality to provide insight into the evolution of practice patterns for nephrolithiasis treatment.
We abstracted data on 12,948 patients undergoing percutaneous procedures for urinary calculi between 1988 and 2002 from the Nationwide Inpatient Sample using International Classification of Disease, 9th revision, Clinical Modification procedure and diagnostic codes. A weighted sample was used to estimate national PCNL use rates. Adjusted models were constructed to measure the association of hospital structure and patient demographics with mortality and a prolonged LOS (greater than 90th percentile).
Annual PCNL use increased temporally during the study from 1.2/100,000 to 2.5/100,000 United States residents (p <0.0001). The in-hospital mortality rate was low at 0.2%, although a volume-outcome relationship was still evident (high and low volume 0.1% and 0.2%, respectively, p = 0.002). Treatment at hospitals with lower hospital PCNL volume and lower discharge volume (all diagnoses) was associated with an increasing likelihood of in-hospital mortality (each p <0.01).
Despite the advent of less invasive techniques PCNL remains a popular means of managing stone disease. Although mortality was rare, it was significantly lower at high than at low volume hospitals. Low short-term mortality rates coupled with shorter LOS and high success rates may make PCNL increasingly palatable from a patient perspective and provide a potential basis for its increasing use.
由于输尿管镜检查和冲击波碎石术等侵入性较小的技术的普及，肾结石的治疗方法已经发生了演变。我们研究了经皮肾镜取石术（PCNL）使用的时间趋势，并确定了住院时间延长和住院死亡率的决定因素，以深入了解肾结石治疗实践模式的演变。
我们使用国际疾病分类第9版临床修订本的手术和诊断编码，从全国住院患者样本中提取了1988年至2002年间12948例接受经皮尿路结石手术患者的数据。使用加权样本估计全国PCNL使用率。构建调整模型以测量医院结构和患者人口统计学与死亡率和住院时间延长（大于第90百分位数）之间的关联。
在研究期间，美国居民的年度PCNL使用率随时间从1.2/100,000增加到2.5/100,000（p<0.0001）。住院死亡率较低，为0.2%，尽管数量-结果关系仍然明显（高容量和低容量分别为0.1%和0.2%，p=0.002）。在PCNL手术量较低且出院量（所有诊断）较低的医院接受治疗与住院死亡率增加的可能性相关（每项p<0.01）。
尽管出现了侵入性较小的技术，但PCNL仍然是治疗结石疾病的常用方法。虽然死亡率很低，但高容量医院的死亡率明显低于低容量医院。低短期死亡率、较短的住院时间和高成功率可能使PCNL从患者角度来看越来越受欢迎，并为其使用增加提供潜在基础。
