Nationwide Readmission Rates Following Percutaneous Nephrolithotomy: Does Age Matter?
Ashley W. Johnston, MD, Ruiyang Jiang, MD, Muhammad H. Alkazemi, MS, Steven Wolf, MS, Gina-Maria Pomann, PhD, Michael E. Lipkin, MD, Charles D. Scales, MD, Jonathan C. Routh, MD.
Duke University, Durham, NC, USA.
Background: 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.
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.
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%). There was a slightly greater proportion of male than females (55.7% vs. 44.3%). The child group had the highest mean length of stay (11.3 d ± 4.8) and hospitalization costs ($35,361 ± 11,362). The child group had the lowest 30-day readmission rate (7.1%), while the 75+ yo group had the highest rate (18.7%). Similarly, the 75+ yo group had the highest rate of post-operative complications (63.2%). Complication rates were similar for all other age groups. 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.
Age is an important factor associated with morbidity following PCNL. We did not find evidence to suggest a difference in 30-day readmissions or post-op complications when comparing both <18 yo and >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. Physicians should appropriately counsel older adults on their increased risk of postoperative readmission and complications following PCNL.
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