Can Activities of Daily Living Predict for Complications Following Percutaneous Nephrolithotomy?
PURPOSE: Activities of daily living provide information about an individual's functional status and can predict for postoperative complications after general and oncological surgery, but have rarely been applied to urology. We evaluated if deficits in activities of daily living could predict for complications after percutaneous nephrolithotomy, and how this compared with the Charlson comorbidity index and the American Society of Anesthesiologist classification. MATERIALS AND METHODS: All patients undergoing percutaneous nephrolithotomy between March 2013 and March 2014 were retrospectively reviewed. Those patients with a complete assessment of activities of daily living were included. Perioperative outcomes, complications and hospital length of stay were examined according to degree of deficits in activities of daily living. RESULTS: Overall 176 patients underwent 192 percutaneous nephrolithotomies. Deficits in activities of daily living were seen in 16% of patients (9% minor, 7% major). Complications occurred more frequently in those with deficits in activities of daily living compared to those without (53% vs 31%, p=0.029), and the length of stay was longer (2.0 vs 4.5 days, p = 0.005). On multivariate logistic regression, activities of daily living were an independent predictor of complications (OR 1.11, p=0.01), while American Society of Anesthesiologists classification and Charlson comorbidity index were not. CONCLUSIONS: Activities of daily living are easily evaluated prior to surgery. They independently predict for complications following percutaneous nephrolithotomy better than the Charlson comorbidity index or the American Society of Anesthesiologists classification. Preoperative assessment of activities of daily living can help risk stratify patients and may inform treatment decisions.
Faculty, Northwell Researcher
School of Medicine; Northwell Health