Does body mass index impact the outcomes of tubeless percutaneous nephrolithotomy?

Abstract

Objective• To evaluate whether body mass index (BMI) has an impact on the outcomes of tubeless percutaneous nephrolithotomy (PCNL). Patients and Methods• We retrospectively reviewed patients who underwent tubeless PCNL at our institution from 2006 to 2011.• Specifically, stone-free rates, complications, and hospital length of stay (LOS) were assessed. • Patients were divided into four groups based on BMI: <25, 25-29.9, 30-34.9 and ≥35 kg/m 2 .• Baseline characteristics and outcomes were compared between BMI groups. Multivariable logistic regressions were used to evaluate the independent contribution of BMI as a predictor of outcomes. Results• We identified 268 patients who fulfilled study requirements. The overall stone-free and complication rates were 52.5% and 19.0%, respectively.• Minor and severe complication comprised 10.4% and 8.6%, respectively. • Univariate and multivariable analyses showed no association between BMI and stone-free or complication rates.• However, patients with a normal BMI had significantly higher transfusion rates (P = 0.005), and were significantly more likely to have a prolonged LOS (≥2 days), when compared with an overweight BMI (P = 0.032) Conclusions• BMI did not impact the stone-free, or complication rates of tubeless PCNL.• Normal BMI was found to be a risk factor for prolonged LOS, which may be due to an increase in clinically significant bleeding in this patient population. Tubeless PCNL appears to be a safe and effective procedure for the treatment of complex renal calculi, independent of BMI.

Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients

“…Agrawal et al [10] reported in a review study that PNL results are not related to BMI and obesity among under-operation subjects. [11] Kuntz et al [11] assessed 268 subjects under tubeless PNL and reported no association between outcomes and reported no effect by obesity on therapeutic outcomes as shown in our study. Another review study by Agrawal et al [12] demonstrated that obese and non-obese subjects had same results in tubeless operations.…”

Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis

“…Sergeyev et al [29] had demonstrated that patients with normal weight had longer hospitalization times when compared with obese patients; they believed that longer hospitalization time was associated with operative or postoperative complications such as bleeding, fever, adjacent organ injuries instead of technical difficulties. Kuntz et al [30] found hospital stay was significantly longer in normal-weight individuals despite lower ASA classification and equivalent stone burden on multivariable analysis. This could be related to postoperative bleeding, as they found a statistically significant increase in the transfusion rates in normal-weight patients.…”

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m2): overcoming the challenges

“…A number of mainly retrospective studies have evaluated PCNL outcomes in obese and morbidly obese patients, although to our knowledge there are no reports on outcomes in the super obese [9][10][11][12][24][25][26][27]. Interestingly, the definition of morbid obesity varies, with some studies using BMI ≥ 35 kg/m 2 as the threshold and others using BMI ≥ 40 kg/m 2 .…”

“…Results from the PCNL Global Study [10] and from Faerber and Goh [28] suggested a higher complication rate (22.1 vs 6.5%), lower stone-free rate (65.6 vs~79%), longer operating time (112 vs~80 min) and more frequent need for auxiliary procedures (28.1 vs 12.4%) in the morbidly obese vs normal weight patients [10,28]. This contrasts with a number of other retrospective studies, which found no significant association in these variables with BMI [9,11,12,26,27].…”