Outcomes of percutaneous nephrolithotomy in spinal cord injury patients as compared to a matched cohort

Abstract

Spinal cord injury patients are at increased risk of developing nephrolithiasis and may require percutaneous nephrolithotomy for treatment of large stone burdens. Our objective was to compare outcomes of PCNL in SCI patients as compared to a matched cohort of non-SCI patients. Data from the Healthcare Cost and Utilization Project State Inpatient Database for Florida and California were used to identify patients by ICD-9 codes who underwent PCNL between 2007 and 2011. SCI was identified by having a paralysis diagnosis on the chronic comorbidity indicator. One-to-one matching was performed based on age, race, gender, presence of preoperative UTI, and major comorbidities. Of the 39,868 unique patients identified, who underwent PCNL, 1918 (4.81%) were SCI patients. After matching, worse perioperative outcomes in SCI patients were demonstrated. SCI patients had significantly longer length of stay, higher rates of sepsis, and increased minor and moderate complications (p < 0.001). Multivariate analysis demonstrated an independently increased risk of mortality, minor and major complications, pneumonia, sepsis, and length of stay in SCI patients. PCNL in SCI patients is associated with a high complication rate and longer hospital stay even when controlling for presence of preoperative UTI and medical comorbidities. To our knowledge, this is the first study of outcomes of PCNL in a large population of SCI patients. These patients represent a high risk population and strategies to decrease complications need to be developed and implemented.

Outcomes of renal calculi in patients with spinal cord injury

“…Of these 31 episodes initially observed, only 5 (16%) went on to require surgical intervention, whereas the remaining 26 (84%) episodes did not require intervention at a median follow-up of 4 years. While the outcomes of surgical interventions for nephrolithiasis in patients with SCI have been described, 5,[12][13][14][15] to our knowledge no prior study has described the clinical outcomes of observed calculi among patients with SCI. In 2002, Chen described 77 patients with SCI and renal stones, and within that cohort 60 patients underwent conservative therapy with an 82% stone-free rate.…”

“…Therefore, it is important to discuss observation as an option. 12,17 For example, the rate of complications for ureteroscopy and PCNL in patients with neurogenic bladder ranges from 12% to 21%. 5,6 Prior studies have proposed that observation of recalcitrant stones in compliant patients could be a reasonable approach to decrease morbidity associated with surgical intervention.…”

“…65%). There were 41 stone episodes with 98 individual stones identified with a mean stone size of 4.9 mm (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Of the 41 episodes, 10 (24%) underwent surgery after initial diagnosis.…”

Postoperative outcomes of kidney stone surgery in patients with spinal cord injury: a systematic review and meta-analysis

“…The pooled population included 4 829 patients, consisting of 2 686 SCI patients and 2 143 non-SCI patients. The majority of patients were included as part of the study by Baldea et al (2016) [31], which included 1 885 patients in both the SCI and non-SCI cohorts. Removing this study from analysis yielded 901 patients in the SCI patient group and 258 patients in the non-SCI group.…”

“…Due its disproportionately large study population, sensitivity analysis performed by removing the study by Baldea et al (2016) [31] from the meta-analysis. Excluding this study did not have a signi cant impact on SFR, minor complications, or infectious complications, but did have a signi cant impact on the observed difference in major complication rates.…”