Abstract: PD21-03
Sources of Funding: none

Introduction

Percutaneous nephrolithotomy (PCNL) is an effective minimally invasive technique for removal of large upper tract urinary stones. Renal access (RA) can be obtained by interventional radiologist or urologist prior to PCNL. The aim of the study was to evaluate the impact of the specialty of the physician obtaining access on perioperative outcomes, complications, and costs of PCNL.

Methods

We used data from the Premier Hospital Database, a nationally representative hospital discharge database, which collects data from over 600 non-federal hospitals throughout the US. We identified patients undergoing PCNL using ICD9-CM codes with a corresponding diagnosis code for nephrolithiasis. Procedure codes related to RA were linked to physician specialty. We examined patient demographics, Charleson comorbidity index (CCI), postoperative complications, length of stay, and direct hospital costs as well as surgeon volume, hospital size, type and location stratified by specialty of the physician obtaining RA. A multivariable regression model was created adjusting for potential confounders.

Results

We identified 19,985 patients undergoing PCNL between 2003-2015. Urologists obtained access in 18.5% of cases. RA by urologist was more commonly performed by high-volume surgeons (37.0% vs 9.8% p<0.001) and hospitals with <400 beds (19.1% vs 17.9% p=0.04). RA by urologist was associated with lower 90-day complication rate (16.9% vs 18.8% p=0.008) and lower rates of prolonged hospitalization >2 days (31.6% vs 68.4%, p<0.001). _x000D_ There was no association between patient&[prime]s CCI, age, race, insurance, hospital location (urban vs non-urban, and hospital type (teaching vs non-teaching) with regard to physician specialty obtaining RA. On multivariable analysis, RA by urologist was associated with lower rates of any complication (Clavien 1-5), shorter hospitalization (<2 days) and lower direct admission costs (<$12,515) Figure 1._x000D_

Conclusions

PCNL is performed with urologists obtaining percutaneous access the minority of the time in the United States. High-volume urologists are more likely to obtain their own access. Access by urologist is associated with lower overall complications, shorter hospitalizations, and lower direct hospital costs.

Funding

none