title: Percutaneous nephrolithotomy in high-risk patients: a single-center experience with more than 350 cases.
abstract: OBJECTIVE
  To assess the surgical outcomes and peri- and postoperative complications following percutaneous nephrolithotomy (PCNL) in high- and low-risk patients according to the American Society of Anesthesiologists (ASA) score.
  
  
  METHODS
  We reviewed the patient records of 2,281 cases older than 18 years who had undergone PCNL in the 3 previous years. The patients were divided into two groups: a low-risk group (ASA score 1, 2: 1,922 cases) and a high-risk group (ASA score 3, 4: 359 cases).
  
  
  RESULTS
  Analysis of the location and size of the stone, number and type of access, surgical approach, post-PCNL serum hemoglobin and decrease in glomerular filtration rate revealed no significant difference between the two groups. The stone-free rate was similar in both groups and the hospital stay in the high-risk patients was significantly greater than in the low-risk cases. 95% of low-risk and 91% of high-risk cases had surgical complications compatible with grade ≤II (Clavien system) and overall distribution of different grades of surgical complications was similar between the two groups (p = 0.177).
  
  
  CONCLUSIONS
  Success rate and surgical complications of PCNL in high-risk patients were comparable to low-risk patients. It seems that PCNL may be a safe and effective procedure even in high-risk patients.
authors.affiliation: Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Akbar
authors.initials: A
authors.lastname: Nouralizadeh
authors.forename: Alireza
authors.initials: A
authors.lastname: Lashay
authors.forename: Seyed Amir Mohsen
authors.initials: SA
authors.lastname: Ziaee
authors.forename: Ali
authors.initials: A
authors.lastname: Ahanian
authors.forename: Seyed Hossein Hosseini
authors.initials: SH
authors.lastname: Sharifi
authors.forename: Mohammad Masoud
authors.initials: MM
authors.lastname: Nikkar
authors.forename: Ardalan
authors.initials: A
authors.lastname: Ojand
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Soltani
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D006801:Humans; D007492:Iran; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome