Category: Clinical Stones: PCNL
Introduction & Objective :
This study aims to investigate the relationship between surgeon case volume and outcomes after percutaneous nephrolithotomy (PCNL) within the UK.
The study used data from the BAUS registry, a mandatory self-reported database which records information on all PCNLs performed in the UK, for 2014 to 2017. Details were retrieved from surgeons in each quartile by volume over the four years, and outcomes compared.
These outcomes included clearance on imaging at day one, blood transfusion, sepsis, complications and post-operative length of stay. These comparisons were made for all stones according to their Guys Stone Score (GSS) complexity, graded from 1-4. Comparisons were carried out using the Chi-squared test.
9231 PCNLs were recorded. 138 surgeons were in the lower quartile, 46 in the second lowest, 27 in the third and 14 surgeons in the highest volume quartile. Complexity of stones by surgeon volume quartile is shown in Table 1.
Surgeons in the lowest quartile had longer median lengths of stay across all GSS stone types. See Table 2. Transfusion rates were similar when comparing the lowest quartile volume surgeons against higher volume surgeons across all stone complexities.
Overall stone clearance, by imaging at day one, was higher in the highest volume quartile surgeons for GSS1 (94% vs 88% p<0.01). It was lower in the lowest volume quartile surgeons for GSS2 (70% v 80%, p<0.01).and GSS3 (51% v 65%, p<0.01). with no difference seen in GSS 4 stones (37% v 40%, p>0.05).
Lower volume surgeons have greater lengths of stay and lower stone free rates after PCNL in the UK.
Oliver Wiseman– Urologist, Cambridge University Hospitals, Urology, Cambridge, United Kingdom, CAMBRIDGE, England, United Kingdom
John Withington– Urology Registrar, Royal Free Hospital NHS Trust, London, England, United Kingdom
Sarah Fowler– London, England, United Kingdom
Jim Armitage– Cambridge, England, United Kingdom
Daron Smith– Consultant Urological Surgeon, Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust, London, England, United Kingdom
Stuart Irving– Norfolk and Norwich University Hospitals, Norwich, England, United Kingdom
Neil Burgess– Norwich, England, United Kingdom
William Finch– Consultant Urological Surgeon, Norfolk and Norwich University Hospitals, Norwich, England, United Kingdom
Cambridge University Hospitals, Urology, Cambridge, United Kingdom
CAMBRIDGE, England, United Kingdom
Oliver is a Consultant Urologist based at Cambridge University Teaching Hospitaks NHS Trust Cambridge, UK. He specialises in the treatment of kidney stones, their metabolic management and in the devlopment of patient reported outcomes for stone disease. He runs a number of training courses teaching stone surgery, and has been invited to operate and lecture nationally and internationally on stone disease.
He qualified in Cambridge and following basic surgical training, he underwent specialist training in urology in London, including at Guys Hospital and UCLH ("The Institute of Urology"). He has published widely including articles relating to the management of patients with renal stone disease.
He is a trustee of BAUS, honorary treasurer elect of BAUS, a member of the BAUS Section of Endourology Committee, and on the Endourological Society Awards and Medals Committee. He is training program director for Urology for the East of England.
Royal Free Hospital NHS Trust
London, England, United Kingdom
Consultant Urological Surgeon
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom
Daron Smith is a consultant urological surgeon at the Institute of Urology at University College Hospital. His practice is "endoluminal endourology" and encompasses the comprehensive management of Urinary Tract Stone disease, and includes the endourological management of ureteric obstruction, ureteric injuries, and the endoscopic diagnosis and management of upper tract TCC. He is the vice-chairman of the BAUS Section of Endourology, having been its Secretary from 2015-17 and a committee member since 2013, is the Consulting Editor on stone disease for the BJUI and the deputy editor of the Journal of Endoluminal Endourology