title: Risk Factors for Postoperative Complications of Percutaneous Nephrolithotomy at a Tertiary Referral Center.
abstract: OBJECTIVE
  We sought to describe and evaluate the complications related to percutaneous nephrolithotomy and identify risk factors of morbidity according to the modified Clavien scoring system. We also sought to specify which perioperative factors are associated with minor and major complications.
  
  
  METHODS
  We retrospectively analyzed data on patients who underwent percutaneous nephrolithotomy from 1990 to 2013. Descriptive statistics were used to analyze patient characteristics, medical comorbidities and perioperative features. Complications were categorized according to the Clavien score for percutaneous nephrolithotomy. The Mann-Whitney and Fisher exact tests were used as appropriate. Logistic regression analysis was performed to look for prognostic factors associated with major complications.
  
  
  RESULTS
  A total of 2,318 surgeries were evaluated. Mean age of the population was 53.7 years. The stone-free rate at hospital discharge was 81.6%. The overall complication rate was 18.3%. Two deaths occurred. Patients with any postoperative complications were older, had more comorbidities, were more likely to have staghorn calculi and had longer operative time and hospital stay on univariate analysis (p<0.05). Age 55 years or older and upper pole access were independent predictors of major complications on multivariate analysis. Other factors such as a history of urinary tract infections, body mass index, stone composition, previous percutaneous nephrolithotomy and multiple tracts were not associated with a major complication.
  
  
  CONCLUSIONS
  At our center percutaneous nephrolithotomy is an excellent option for complex kidney stone management with a low overall complication rate. Older patient age and upper pole access are significantly associated with an increased risk of a major complication.
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Olvera-Posada
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tailly
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Husain
authors.initials: H
authors.lastname: Alenezi
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Philippe D
authors.initials: PD
authors.lastname: Violette
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Nott
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: Hassan.Razvi@sjhc.london.on.ca.
authors.forename: Hassan
authors.initials: H
authors.lastname: Razvi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007669:Kidney Calculi / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012017:Referral and Consultation; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: kidney; nephrolithiasis; nephrostomy; percutaneous; postoperative complications; risk