title: Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy.
abstract: OBJECTIVE
  In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL).
  
  
  METHODS
  Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale.
  
  
  RESULTS
  The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1-8), and length of hospital stay was 4.91±1.54 (2-17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (p<0.001). When intraoperative complications were evaluated one by one, intraoperative hypotension developed in ASA I (n=3; 1.8%), ASA II (n=20; 6.4%) and ASA III (n=11; 13.4%) risk groups and this distribution (p=0.002) of patients was statistically significant. When assessed according to Clavien Postoperative Scale, postoperative complications developed (p=0.053) in ASAI (n=24; 14.7%), ASA II (n=27, 8.6%) and ASA III (n=13; 15.9%) risk groups, and this distribution of the patients was not statistically significant. In postoperative complications, Grade 3a complications developed in ASA I (n=12; 7.4%), ASA II (n=19; 6%) and ASA III (n=8; 9.8%) risk groups and this distribution was not seen to be statistically significant (p=0.485).
  
  
  CONCLUSIONS
  A statistically significant difference observed regarding intraoperative complications in the groups formed according to ASA risk criteria, on Clavien Grading scale no statistically significant difference was observed as for postoperative complications. In this context, we considered that ASA risks are major risk factors for PNL operations in terms of intraoperative complications.
authors.affiliation: Clinic of Urology, Hinis Şehit Yavuz Yürekseven State Hospital, Erzurum, Turkey.
authors.forename: Hüseyin Buğra
authors.initials: HB
authors.lastname: Karakaş
authors.affiliation: Department of Urology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: İzzet
authors.initials: İ
authors.lastname: Çiçekbilek
authors.affiliation: Department of Urology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Tok
authors.affiliation: Department of Urology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Alışkan
authors.affiliation: Department of Urology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Akduman
keywords: ASA; Clavien; percutaneous nephrolithotomy; postoperative complications