title: Trends in the utilization of percutaneous and open nephrolithotomy in the treatment of renal calculi.
abstract: OBJECTIVE
  To evaluate trends in the use of percutaneous nephrolithotomy (PCNL) and nephrolithotomy (NL) in patients with renal pelvis calculi.
  
  
  METHODS
  An analysis of the 5% Medicare Public Use Files (years 2001, 2004, 2007, and 2010) was performed to assess changes in the use of PCNL and NL over a 10-year period. Patients were identified using the International Classification of Diseases-9 (cm) and Current Procedure Terminology codes. Statistical analyses, including the Fisher and chi-square tests and multivariate regression analyses, were performed using SAS 9.3 (SAS Institute Inc, Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY).
  
  
  RESULTS
  A total of 26,100 patients underwent either PCNL or NL. Use of PCNL and NL decreased from 3.1% to 2.5% in patients with a diagnosis of stones (P<0.0001). Women (odds ration [OR]=1.19, P=0.003) were more likely to undergo surgery. Patients aged ≥65 years were less likely to be treated (OR=0.65-0.71, P<0.05). Patients treated after 2004 were less likely to undergo surgery (OR=0.77-0.84, P<0.05). The use of PCNL exceeded NL at a stable 10:1 ratio.
  
  
  CONCLUSIONS
  The use of PCNL and NL for treatment of patients with stone disease slightly decreased from 2001 to 2010, although the number of patients with renal calculi increased. The use of PCNL vs NL was unchanged during this period. Multiple inequalities existed in overall surgical treatment rates and were influenced by sociodemographic factors such as age and sex.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York 10065, USA. st.seklehner@gmx.net
authors.forename: Stephan
authors.initials: S
authors.lastname: Seklehner
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Laudano
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Asha
authors.initials: A
authors.lastname: Jamzadeh
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Del Pizzo
authors.forename: Paul F
authors.initials: PF
authors.lastname: Engelhardt
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000706:statistics & numerical data* / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology