Category: Clinical Stones: Pediatrics

MP9-11 - Nationwide Readmission Rates Following Percutaneous Nephrolithotomy: Does Age Matter?

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : Percutaneous nephrolithotomy (PCNL) remains the gold-standard for stone burden > 2cm and staghorn calculi. Although PCNL has proven to be safe and successful in adult and pediatric patients, there is a lack of literature that directly evaluates age as a comorbidity factor. Our objective was to use a nationally representative database to determine differences in 30-day readmission and complication rates following PCNL between age groups.  We hypothesized that the extremes of the age range would have higher complication rates than other age groups.


Methods :

We analyzed the 2013-2014 Nationwide Readmission Databases. We used ICD-9 codes to identify all patients diagnosed with renal stones who underwent PCNL. Patients were divided into 5 age groups: child (<18 years old), young adult (18-25yo), adult (26-64yo), and older adults subdivided into 65-74yo and 75+ yo. Patients with urologic congenital anomalies and those who underwent renal transplantation at the time of PCNL were excluded. December encounters were excluded to impose a 30-day follow-up window. Weighted descriptive statistics were used to describe population demographics. We fit a weighted logistic regression model for 30-day readmission and complication rates.


Results :

We identified 23,357 encounters. The average age was 56 + 0.2 years. Adult patients represented the largest age cohort (62.3%), followed by 65-74yo (21%), 75+ yo (12.1%), young adults (3.4%), and children (1.2%). After adjusting for confounders, comparing both child and 75+ yo patients to other age groups, there was insufficient evidence to suggest a difference in 30-day readmissions and post-op complications. However, when comparing 75+ yo encounters to all other age groups, we found that the 75+yo group had increased odds of having a 30-day readmission (OR 4.4, 95%CI 1.4-13.5) and at least one post-op complication (OR 17.3, 95%CI 7.3-40.8) compared to all other age groups<./p>


Conclusions :

Contrary to our hypothesis, we did not find evidence to suggest a difference in 30-day readmissions or post-op complications when comparing both 75 yo encounters to other age groups. However, when comparing the 75+yo patients alone against all other age groups, we found that very old patients had increased odds of a 30-day readmission and post-operative complications compared to all other age groups<./p>

Jonathan C. Routh

M.D.
Duke University Medical Center, Division of Urology
Durham, North Carolina

Ashley W. Johnston

Duke University Medical Center, Division of Urology
Durham, North Carolina

Ruiyang Jiang

Duke University Medical Center, Division of Urology
Durham, North Carolina

Muhammad H. Alkazemi

Duke University, School of Medicine
Durham, North Carolina

Steven Wolf

Duke University Medical Center, Department of Biostatistics and Bioinformatics
Durham, North Carolina

Gina-Maria Pomann

Duke University Medical Center, Department of Biostatistics and Bioinformatics
Durham, North Carolina

Michael E. Lipkin

Associate Professor Urology
Duke University Medical Center, Division of Urology
Durham, North Carolina

Charles D. Scales

Associate Professor
Duke University Medical Center, Division of Urology
Durham, North Carolina

Charles D. Scales, Jr., MD MSHS is Associate Professor of Surgery (Urology) and Population Health at Duke University School of Medicine and Vice Chief for Quality Improvement and Patient Safety in the Division of Urologic Surgery. He completed medical school and residency training in urology at Duke University Medical Center. After residency, Dr. Scales completed the Robert Wood Johnson Foundation Clinical Scholars Program at UCLA, where he received advanced training in health services research, health policy, and quality of care.

Dr. Scales has a strong interest in education, having previously served on the ACGME Review Committee for Urology and as a member of the ACGME Board of Directors. He currently leads a course in quality improvement and data analytics in the Masters of Management in Clinical Informatics program at the Duke University School of Medicine.

From the research perspective, Dr. Scales has a longstanding interest in the epidemiology of and patient care for urinary stone disease. Recent studies have redefined the burden of urinary stone disease in the United States, compared the effectiveness of dominant stone removal technologies, and identified new opportunities for improving patient-centered and policy-relevant outcomes, such as unplanned care after procedural interventions. His research and perspective on urinary stone disease has been highlighted in U.S. News & World Report, Reuters, NPR, and the Wall Street Journal, among other media outlets.

As a result of these investigations, he has an appointment at the Duke Clinical Research Institute where he leads a diverse health services and clinical research program. He has received research support from the National Institute of Aging, the American Geriatrics Society, and philanthropic funding, among other sources. Currently, Dr. Scales is the Principal Investigator for the Scientific Data and Research Center for the NIDDK Urinary Stone Disease Research Network (U01).