Munich, Germany (UroToday.com) Previous studies have shown the case volume is significantly associated with surgical outcomes following percutaneous nephrolithotomy (PCNL). Withington and colleagues evaluated BAUS database to investigate the relationship between volume and stone clearance, adjusted for stone complexity.
The data for this study was obtained from the prospective British Association of Urological Surgeons PCNL registry. Authors defined two approximately equal sized groups; hospitals performing fewer than 20 and those performing 20 or more cases per year. A series of comparisons was performed between these volume-defined groups, including stone complexity and outcomes, including stone clearance at day one, blood transfusion, sepsis and median post-operative Length Of Stay (LOS).
A total of 2,042 PCNL procedures were recorded in the registry in 2014. There was no significant difference between stone complexity or stone dimensions between the two groups.
Stone free rate at postoperative day 1 was significantly higher in high volume center compared to low volumes (73% vs. 63%, p<0.05). This was true for both complex and non-complex stones (55% vs. 45%, p<0.05; 85% vs. 77%, p<0.05).
There was no difference in complications including bleeding, transfusion or any side effects. Overall, median total Length Of Stay (LOS) was shorter at high volume centres than low volume centres (2d vs 3d).
Dr. Withington stated that hospital volume does not appear to significantly affect transfusion or sepsis rates after PCNL; stone complexity appears to be more relevant to these outcomes. Stone clearance, however is clearly associated with hospital volume, higher volume centres achieving significantly higher stone free rates, for both complex and non-complex stones. This data is consistent with previously reported publications.
Presented By:
Withington J.
Whittington Hospital NHS Trust, Dept. of Urology, London, United Kingdom
Reported by
Zhamshid Okhunov, MD, at the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany
UC Irvine Urology