title: The clinical research office of the endourological society percutaneous nephrolithotomy global study: Outcomes in the morbidly obese patient - a case control analysis.
abstract: BACKGROUND
  Efficacy and safety of percutaneous nephrolithotomy (PCNL) have been demonstrated in obese individuals. Yet, there is a paucity of data on the outcomes of PCNL in morbidly obese patients (body mass index [BMI] >40).
  
  
  METHODS
  Perioperative and stone-related outcomes following PCNL in morbidly obese patients was assessed using a prospective database administered by the Clinical Research Office of the Endourological Society (CROES). A multidimensional match of 97 morbidly obese patients with those of normal weight was created using propensity score matching. Student's t-test and Chi-square tests were used to assess for differences between the groups.
  
  
  RESULTS
  In total, 97 patients with a BMI >40 kg/m(2) were matched by stone characteristics with 97 patients of normal weight. The morbidly obese population demonstrated higher rates of diabetes mellitus (43% vs. 6%, p < 0.001) and cardiovascular disease (56% vs. 18%, (p < 0.001). Access was achieved more frequently by radiologists in the morbidly obese group (19% vs. 6%, p = 0.016). Mean operative duration was longer in the morbidly obese group (112 ± 56 min vs. 86 ± 43.5 min, p < 0.001). Stone-free rates were lower in the morbidly obese group (66% vs. 77%, p = 0.071). There was no significant difference in length of hospital stay or transfusion rate. Morbidly obese patients were significantly more likely to experience a postoperative complication (22% vs. 6%, p = 0.004).
  
  
  CONCLUSIONS
  PCNL in morbidly obese patients is associated with longer operative duration, higher rates of re-intervention and an increased risk of perioperative complications. With this knowledge, urologists should seek to develop strategies to optimize the perioperative management of such patients.
authors.affiliation: Division of Urology, Department of Surgery, Western University, London, ON;
authors.forename: Andrew
authors.initials: A
authors.lastname: Fuller
authors.affiliation: Division of Urology, Department of Surgery, Western University, London, ON;
authors.forename: Hassan
authors.initials: H
authors.lastname: Razvi
authors.affiliation: Division of Urology, Department of Surgery, Western University, London, ON;
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
authors.affiliation: Division of Urology, Department of Surgery, Western University, London, ON;
authors.forename: Linda
authors.initials: L
authors.lastname: Nott
authors.affiliation: Department of Urology, Catharina Hospital, Eindhoven, The Netherlands;
authors.forename: Ad
authors.initials: A
authors.lastname: Hendrikx
authors.affiliation: Department of Urology, Herlev Hospital, Herlev, Denmark;
authors.forename: Michael
authors.initials: M
authors.lastname: Luke
authors.affiliation: Department of Urology, Lions Kidney Hospital and Urology Research Institute New Friends Colony, New Delhi, India; Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
authors.forename: S K
authors.initials: SK
authors.lastname: Pal
authors.affiliation: Division of Urology, Department of Surgery, Western University, London, ON;
authors.forename: Jean
authors.initials: J
authors.lastname: de la Rosette