Nottingham Charles U, Cohen Andrew J, Packiam Vignesh T, Pariser Joseph J, Gerber Glenn S
Department of Surgery, Section of Urology, University of Chicago Medicine , Chicago, Illinois.
J Endourol. 2017 Jan;31(1):78-84. doi: 10.1089/end.2016.0672. Epub 2016 Nov 17.
To determine trends in pyelolithotomy, evaluate risk factors for complications, and evaluate the difference in outcomes and charges between open and minimally invasive (MI) techniques.
We used the Nationwide Inpatient Sample to identify patients with a diagnosis of having nephrolithiasis undergoing pyelolithotomy from 2008 to 2012. Total charges were inflation-adjusted to U.S. dollars in 2012. Patient demographics, hospital characteristics, and outcomes were reported and compared between open and MI groups after survey weighting.
We included a survey-weighted population of 17,294 patients, of whom 841 (4.9%) had MI pyelolithotomy. The proportion of MI cases increased by 2.57% annually (r = 0.921, p = 0.01), although total pyelolithotomy cases remained stable. Simultaneous pyeloplasty occurred in 6.6% of all patients. Patients receiving open surgery experienced longer length of stay (3.9 days vs 2.7 days; p < 0.001), but accrued equivalent inflation-adjusted charges ($49,588 ± 2088 vs $51,716 ± 4893; p = 0.665). On multivariable analysis, higher Elixhauser comorbidity index and presence of any genitourinary anomaly were associated with experiencing a complication, while undergoing surgery at a top quartile hospital and elective admission status were protective against complications. MI technique and simultaneous ureteropelvic junction repair did not alter complication risk.
While the annual number of pyelolithotomy cases was stable, there was an increasing trend toward MI technique. Both patient and hospital factors can significantly alter the risk for complications following pyelolithotomy.
确定肾盂切开取石术的发展趋势，评估并发症的危险因素，并评估开放手术与微创技术在治疗效果和费用方面的差异。
我们利用全国住院患者样本，识别出2008年至2012年期间诊断为肾结石并接受肾盂切开取石术的患者。总费用经通货膨胀调整为2012年的美元价值。报告患者人口统计学资料、医院特征及治疗效果，并在调查加权后对开放手术组和微创组进行比较。
我们纳入了经调查加权后的17294例患者，其中841例（4.9%）接受了微创肾盂切开取石术。尽管肾盂切开取石术的总病例数保持稳定，但微创病例的比例每年增加2.57%（r = 0.921，p = 0.01）。所有患者中有6.6%同时进行了肾盂成形术。接受开放手术的患者住院时间更长（3.9天对2.7天；p < 0.001），但经通货膨胀调整后的费用相当（49588 ± 2088美元对51716 ± 4893美元；p = 0.665）。多变量分析显示，较高的埃利克斯豪泽合并症指数和任何泌尿生殖系统异常的存在与发生并发症相关，而在四分位排名靠前的医院接受手术和择期入院状态则可预防并发症。微创技术和同时进行输尿管肾盂连接部修复并未改变并发症风险。
虽然肾盂切开取石术的年病例数稳定，但微创技术呈上升趋势。患者因素和医院因素均可显著改变肾盂切开取石术后的并发症风险。
