Introduction Calculous nephrectomy was a mainstay of treatment of complex upper tract stone disease up until the 1970s, but data on its contemporary utilization in the current era of rising rates of stone disease are lacking. We characterized the nationwide utilization and outcomes for calculous nephrectomy in the United States. Patients and Methods The National/Nationwide Inpatient Sample (NIS) databases for 2001-2014 were queried for adults with a principal diagnosis of upper urinary tract calculi (UUTC), who underwent nephrectomy as well as other inpatient surgeries for UUTC. Per-population trend in the utilization of calculous nephrectomy was analysed using negative binomial regression. Proportion of calculous nephrectomy as a fraction of all inpatient surgical procedures for UUTC was analysed using the Cochran-Armitage test. Patient demographics, hospital characteristics, perioperative outcomes and complications were analysed using the appropriate statistical tests. Results Of almost 1.42 million inpatient UUTC procedures performed over the study period, 9,232 (0.65%) were calculous nephrectomies. Per-population utilization rate for calculous nephrectomy decreased significantly over time (incidence rate ratio = 0.82; 95% CI = 0.73- 0.91, p<0.001). Proportion of calculous nephrectomy as a fraction of all inpatient surgical procedures for UUTC also decreased significantly over time (p<0.0001). Majority of the procedures were performed in females, in urban teaching hospitals, and in the Southern United States. Overall complication rate was 38.3%, most commonly hemorrhage requiring transfusion (15.6%). Older age, female gender and non-private insurance or lack of insurance were significant predictors of increased risk of complications, whereas hospitalization in urban hospitals was a predictor of lower risk. Conclusions Despite increasing prevalence of stone disease in the United States in the contemporary era, the utilization of calculous nephrectomy is low and is declining. Inpatient complication rates are moderately high and influenced by patient socio-demographic and hospital characteristics.
Journal of endourology. 2019 Mar 05 [Epub ahead of print]
Sairamya Bodempudi, Viktor Dombrovskiy, Ephrem Odoy Olweny
Rutgers Robert Wood Johnson Medical School New Brunswick, 43982, New Brunswick, New Jersey, United States ; ., Rutgers Robert Wood Johnson Medical School New Brunswick, 43982, New Brunswick, New Jersey, United States ; ., Rutgers Robert Wood Johnson Medical School New Brunswick, 43982 , 1 Robert Wood Johnson Pl, MEB 583 , New Brunswick, New Jersey, United States , 08901 ; .