title: Can Activities of Daily Living Predict Complications following Percutaneous Nephrolithotomy?
abstract: Activities of daily living provide information about the functional status of an individual and can predict postoperative complications after general and oncological surgery. However, they have rarely been applied to urology. We evaluated whether deficits in activities of daily living could predict complications after percutaneous nephrolithotomy and how this compares with the Charlson comorbidity index and the ASA(®) (American Society of Anesthesiologists(®)) classification.
  
  
  
  We retrospectively reviewed the records of all patients who underwent percutaneous nephrolithotomy between March 2013 and March 2014. Those with complete assessment of activities of daily living were included in analysis. Perioperative outcomes, complications and hospital length of stay were examined according to the degree of deficits in daily living activities.
  
  
  
  Overall 176 patients underwent a total of 192 percutaneous nephrolithotomies. Deficits in activities of daily living were seen in 16% of patients, including minor in 9% and major in 7%. Complications developed more frequently in those with vs without deficits in daily living activities (53% vs 31%, p = 0.029) and length of stay was longer (2.0 vs 4.5 days, p = 0.005). On multivariate logistic regression activities of daily living were an independent predictor of complications (OR 1.11, p = 0.01) but ASA classification and Charlson comorbidity index were not.
  
  
  
  Activities of daily living are easily evaluated prior to surgery. They independently predict complications following percutaneous nephrolithotomy better than the Charlson comorbidity index or the ASA classification. Preoperative assessment of daily living activities can help risk stratify patients and may inform treatment decisions.
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York; Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan. Electronic address: david.a.leavitt@gmail.com.
authors.forename: David A
authors.initials: DA
authors.lastname: Leavitt
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York; Department of Urology, Yale University, New Haven, Connecticut.
authors.forename: Piruz
authors.initials: P
authors.lastname: Motamedinia
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Shamus
authors.initials: S
authors.lastname: Moran
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Siev
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Philip T
authors.initials: PT
authors.lastname: Zhao
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Nithin
authors.initials: N
authors.lastname: Theckumparampil
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Mathew
authors.initials: M
authors.lastname: Fakhoury
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York; Rutgers Cancer Institute, New Brunswick, New Jersey.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elsamra
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: David
authors.initials: D
authors.lastname: Hoenig
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Arthur
authors.initials: A
authors.lastname: Smith
authors.affiliation: Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York.
authors.forename: Zeph
authors.initials: Z
authors.lastname: Okeke
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods
keywords: activities of daily living; kidney calculi; nephrostomy, percutaneous; postoperative complications; risk