title: Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index.
abstract: OBJECTIVE
  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.
authors.affiliation: Kecioren Training and Research Hospital, Department of Urology, and Hacettepe University, Faculty of Science, Department of Statistics, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Unsal
authors.forename: Berkan
authors.initials: B
authors.lastname: Resorlu
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Atmaca
authors.forename: Akif
authors.initials: A
authors.lastname: Diri
authors.forename: Hasan Nedim Goksel
authors.initials: HN
authors.lastname: Goktug
authors.forename: Ceren Eda
authors.initials: CE
authors.lastname: Can
authors.forename: Bahri
authors.initials: B
authors.lastname: Gok
authors.forename: Can
authors.initials: C
authors.lastname: Tuygun
authors.forename: Cankon
authors.initials: C
authors.lastname: Germiyonoglu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D053040:Nephrolithiasis / Q000175:diagnosis / Q000601:surgery*; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult