Cost analysis and perioperative outcomes between mini-percutaneous nephrolithotomy with vacuum cleaner effect or with a vacuum-assisted access sheath

2021 ◽  
Vol 79 ◽  
pp. S400
Author(s):  
L. Boeri ◽  
I. Fulgheri ◽  
E. Lievore ◽  
M. Turetti ◽  
C. Bebi ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Percutaneous Nephrolithotomy ◽  
Perioperative Outcomes ◽  
Vacuum Cleaner ◽  
Access Sheath

Perioperative Outcomes of Percutaneous Nephrolithotomy in Septuagenarians and Beyond

2021 ◽  
Vol 104 (9) ◽  
pp. 1497-1502
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Renal Calculus ◽  
Perioperative Outcomes ◽  
Kidney Calculi ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Background: Life expectancy has continuously risen worldwide. Because the elderly may tolerate complications poorly, the risks and benefits of percutaneous nephrolithotomy (PCNL) in those patients should be discussed thoroughly. Objective: To analyze utility and operative outcomes of PCNL with respect to age. Materials and Methods: A retrospective study of PCNL was performed at Ramathibodi Hospital between 2011 and 2020. The patients were divided into two age groups, 1) below 70 years old and 2) 70 years old and above. Comparison of demographics, operative data, and postoperative outcomes were analyzed. Results: Of the 253 patients, the overall stone-free rate (SFR) was 59.7%. The SFR in younger groups and older groups were 59.4% (126/212) and 61.0% (25/41), respectively, which was not significantly different (p=0.999). There was a similar in-stone burden between the two groups (p=0.573). Patients in the older group had worse renal function, higher American Society of Anesthesiologists score, and more comorbidities, including hypertension and ischemic heart disease. However, estimated blood loss, length of hospital stay, operative time, percent change in eGFR, and complications were comparable between the groups. Conclusion: PCNL is a safe and effective treatment of kidney calculi in septuagenarians and older patients, even with the risk of higher comorbidities and poorer renal function than in younger patients. Keywords: Percutaneous nephrolithotomy; Renal calculus; Stone-free status; Septuagenarians

A Comprehensive Comparison of Guy’s Stone Score, CROES Nomogram, S.T.O.N.E. Nephrolithometry, and the Seoul Renal Stone Complexity Scoring System in Predicting Perioperative Outcomes after Percutaneous Nephrolithotomy

2020 ◽  
Vol 103 (8) ◽  
pp. 762-766
Keyword(s):  
Free Group ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Scoring System ◽  
Renal Stone ◽  
Length Of Hospital Stay ◽  
Scoring Systems ◽  
Postoperative Outcomes ◽  
Perioperative Outcomes ◽  
National University

Background: Various nephrolithometry scoring systems (NSS) are proposed to determine the structural configuration of kidney stones. Nevertheless, evidence of the comparison among these scoring systems in anticipating postoperative outcomes after percutaneous nephrolithotomy (PCNL) are limited. Objective: To compare the correlation of four NSS with stone-free rates and perioperative results following PCNL. Materials and Methods: The authors examined a retrospective study of patients with kidney stones who received PCNL. One hundred seventy-two patients admitted for surgery at Ramathibodi Hospital were assessed. Four NSS were compared, Guy’s Stone Score (GSS), the Clinical Research Office of the Endourological Society nephrolithometric nomogram (CROES), S.T.O.N.E. Nephrolithometry (STONE), and the Seoul National University Renal Stone Complexity (S-ReSC) scoring system. The authors evaluated the correlations between these four scoring systems with stone-free rates and postoperative outcomes. Results: The stone-free status was 53.5%. There were significant differences in the mean scores of the four systems between the stone-free group and the not stone-free group (1.97 versus 3.70, p<0.05 in GSS; 242.40 versus 159.28, p<0.05 in CROES; 6.64 versus 9.08, p<0.05 in STONE; and 3.44 versus 8.41, p<0.05 in S-ReSC). Multivariate analysis revealed only S-ReSC as independent preoperative factors for PCNL success (p<0.001). Moreover, each scale had a significant correlation with blood loss, length of hospital stay, and operative time. Three scoring systems, all except STONE, were significantly associated with percentage change in estimated glomerular filtration rates (eGFR). There was no significant association among all four scoring systems with postoperative complications. Conclusion: All four NSS represent excellent predictors for stone-free rates and correlate well with surgical outcomes. Keywords: GSS, CROES, STONE, S-ReSC, Percutaneous nephrolithotomy

scholarly journals Comparison of efficacy of laser lithotripter with ultrasonic lithotripter in mini percutaneous nephrolithotomy

2016 ◽  
Vol 87 (4) ◽  
pp. 276
Author(s):  
Fatih Akbulut ◽  
Onur Kucuktopcu ◽  
Emre Kandemir ◽  
Erkan Sonmezay ◽  
Abdulmuttalip Simsek ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Fluoroscopy Time ◽  
Total Operative Time ◽  
Laser Group ◽  
Group 2 ◽  
The Cost ◽  
Group 1

Objective: The aim of the study was to compare the efficacy of the laser lithotripter with the ultrasonic lithotripter in mini percutaneous nephrolithotomy (miniperc). Material and Methods: From June 2013 to January 2014; medical records of 77 consecutive patients who underwent miniperc operation were retrospectively evaluated. Ultrasonic lithotripter was used in 22 patients (Group 1), while laser was used in 55 patients. In the laser group, 22 patients were randomly selected who had same characteristics compared to group 1 (Group 2). Success rate, total operative time, complications according to modified Clavien classification, fluoroscopy time, haemoglobin drop, hospital stays and cost analysis were assessed. Success rates were evaluated on the second postoperative day and after the first month. Results: Total operative time (p = 0.635) and fluoroscopy time (p = 0.248) were not significantly different between the two groups. In the laser group, the success rate (81.8%) was notably more than in the ultrasonic lithotripter group (68.2%) but there was no statistically significance (p = 0.296). Ten reusable ultrasonic probe were used for 22 patients, due to thinness and sensitiveness of the probe. Conversely, one single laser fiber (550 micron) was used for 22 patients. When the cost analysis of lithotripsy was considered, the cost per case was 190 dollar in group 1 and 124 dollar in group 2. (p = 0.154) Complication rate, hospital stay and haemoglobin drop were similar in both groups. Conclusion: Laser lithotripsy seems to be more cost effective than ultrasonic lithotripsy for miniperc but larger number of patients are required to confirm this estimation.

scholarly journals Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath

2021 ◽  
Author(s):  
Elena Lievore ◽  
Stefano Paolo Zanetti ◽  
Irene Fulgheri ◽  
Matteo Turetti ◽  
Carlo Silvani ◽  
...  
Keyword(s):  
Linear Regression ◽  
Cost Analysis ◽  
Percutaneous Nephrolithotomy ◽  
Linear Regression Analysis ◽  
Economic Benefits ◽  
Linear Regression Models ◽  
Academic Center ◽  
Hospitalization Costs ◽  
Lower Complication ◽  
Multivariable Linear Regression Analysis

Abstract Purpose To perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures. Methods We analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs. Results Operative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p < 0.001), but total procedural costs were equivalent (p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p < 0.001). Multivariable linear regression analysis revealed that LOS and OT were associated with hospitalization costs (all p < 0.001), after accounting for vmPCNL procedure, patients’ comorbidities, and complications. Conclusion vmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs.

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