Postoperative complications after percutaneous nephrolithotomy

A contemporary analysis by insurance status in the United States

Mark D. Tyson, Mitchell R Humphreys

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and Purpose: No published data to date have assessed the insurance-related disparities among patients undergoing percutaneous nephrolithotomy (PCNL). Our objective was to examine whether being uninsured is associated with more perioperative complications after PCNL in the United States and to determine possible risk factors that influence PCNL outcomes. Patients and Methods: This retrospective cohort study evaluated 13,982 patients who underwent PCNL and were included in Nationwide Inpatient Sample from 1998 through 2010. The main outcome measure was ≥1 perioperative complication stratified by insurance status. Associations between this outcome and insurance status were examined using logistic regression models. Results: The overall percentage of patients with ≥1 perioperative complication after PCNL was 14.4% (n=2008). When stratified by insurance status, the unadjusted analysis showed significantly higher complication rates among Medicare (17.1%) and Medicaid (16.9%) beneficiaries than privately insured (12.3%) and uninsured (13.4%) patients (P<0.001). In a fully adjusted analysis of patients without medical comorbidity, however, these differences were no longer statistically significant, even when stratified by hospital teaching status. Multivariable-adjusted analysis of preoperative medical comorbidity showed that pulmonary disorders (odds ratio [OR], 7.77; 95% confidence interval [CI], 4.54-13.31), coagulopathy (OR, 6.16; 95% CI, 4.27-8.89), deficiency anemias (OR, 3.82; 95% CI, 3.29-4.44), and paralysis (OR, 2.16; 95% CI, 1.78-2.61) were the strongest predictors of ≥1 perioperative complication. Conclusions: Perioperative morbidity after PCNL varied significantly with insurance status, but this variation was explained mostly by differences in overall health status.

Original languageEnglish (US)
Pages (from-to)291-297
Number of pages7
JournalJournal of Endourology
Volume28
Issue number3
DOIs
StatePublished - Mar 1 2014

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Percutaneous Nephrostomy
Insurance Coverage
Odds Ratio
Confidence Intervals
Comorbidity
Logistic Models
Medicaid
Medicare
Insurance
Teaching Hospitals
Paralysis
Health Status
Anemia
Inpatients
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Morbidity
Lung

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Postoperative complications after percutaneous nephrolithotomy: A contemporary analysis by insurance status in the United States",
abstract = "Background and Purpose: No published data to date have assessed the insurance-related disparities among patients undergoing percutaneous nephrolithotomy (PCNL). Our objective was to examine whether being uninsured is associated with more perioperative complications after PCNL in the United States and to determine possible risk factors that influence PCNL outcomes. Patients and Methods: This retrospective cohort study evaluated 13,982 patients who underwent PCNL and were included in Nationwide Inpatient Sample from 1998 through 2010. The main outcome measure was ≥1 perioperative complication stratified by insurance status. Associations between this outcome and insurance status were examined using logistic regression models. Results: The overall percentage of patients with ≥1 perioperative complication after PCNL was 14.4{\%} (n=2008). When stratified by insurance status, the unadjusted analysis showed significantly higher complication rates among Medicare (17.1{\%}) and Medicaid (16.9{\%}) beneficiaries than privately insured (12.3{\%}) and uninsured (13.4{\%}) patients (P<0.001). In a fully adjusted analysis of patients without medical comorbidity, however, these differences were no longer statistically significant, even when stratified by hospital teaching status. Multivariable-adjusted analysis of preoperative medical comorbidity showed that pulmonary disorders (odds ratio [OR], 7.77; 95{\%} confidence interval [CI], 4.54-13.31), coagulopathy (OR, 6.16; 95{\%} CI, 4.27-8.89), deficiency anemias (OR, 3.82; 95{\%} CI, 3.29-4.44), and paralysis (OR, 2.16; 95{\%} CI, 1.78-2.61) were the strongest predictors of ≥1 perioperative complication. Conclusions: Perioperative morbidity after PCNL varied significantly with insurance status, but this variation was explained mostly by differences in overall health status.",
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N2 - Background and Purpose: No published data to date have assessed the insurance-related disparities among patients undergoing percutaneous nephrolithotomy (PCNL). Our objective was to examine whether being uninsured is associated with more perioperative complications after PCNL in the United States and to determine possible risk factors that influence PCNL outcomes. Patients and Methods: This retrospective cohort study evaluated 13,982 patients who underwent PCNL and were included in Nationwide Inpatient Sample from 1998 through 2010. The main outcome measure was ≥1 perioperative complication stratified by insurance status. Associations between this outcome and insurance status were examined using logistic regression models. Results: The overall percentage of patients with ≥1 perioperative complication after PCNL was 14.4% (n=2008). When stratified by insurance status, the unadjusted analysis showed significantly higher complication rates among Medicare (17.1%) and Medicaid (16.9%) beneficiaries than privately insured (12.3%) and uninsured (13.4%) patients (P<0.001). In a fully adjusted analysis of patients without medical comorbidity, however, these differences were no longer statistically significant, even when stratified by hospital teaching status. Multivariable-adjusted analysis of preoperative medical comorbidity showed that pulmonary disorders (odds ratio [OR], 7.77; 95% confidence interval [CI], 4.54-13.31), coagulopathy (OR, 6.16; 95% CI, 4.27-8.89), deficiency anemias (OR, 3.82; 95% CI, 3.29-4.44), and paralysis (OR, 2.16; 95% CI, 1.78-2.61) were the strongest predictors of ≥1 perioperative complication. Conclusions: Perioperative morbidity after PCNL varied significantly with insurance status, but this variation was explained mostly by differences in overall health status.

AB - Background and Purpose: No published data to date have assessed the insurance-related disparities among patients undergoing percutaneous nephrolithotomy (PCNL). Our objective was to examine whether being uninsured is associated with more perioperative complications after PCNL in the United States and to determine possible risk factors that influence PCNL outcomes. Patients and Methods: This retrospective cohort study evaluated 13,982 patients who underwent PCNL and were included in Nationwide Inpatient Sample from 1998 through 2010. The main outcome measure was ≥1 perioperative complication stratified by insurance status. Associations between this outcome and insurance status were examined using logistic regression models. Results: The overall percentage of patients with ≥1 perioperative complication after PCNL was 14.4% (n=2008). When stratified by insurance status, the unadjusted analysis showed significantly higher complication rates among Medicare (17.1%) and Medicaid (16.9%) beneficiaries than privately insured (12.3%) and uninsured (13.4%) patients (P<0.001). In a fully adjusted analysis of patients without medical comorbidity, however, these differences were no longer statistically significant, even when stratified by hospital teaching status. Multivariable-adjusted analysis of preoperative medical comorbidity showed that pulmonary disorders (odds ratio [OR], 7.77; 95% confidence interval [CI], 4.54-13.31), coagulopathy (OR, 6.16; 95% CI, 4.27-8.89), deficiency anemias (OR, 3.82; 95% CI, 3.29-4.44), and paralysis (OR, 2.16; 95% CI, 1.78-2.61) were the strongest predictors of ≥1 perioperative complication. Conclusions: Perioperative morbidity after PCNL varied significantly with insurance status, but this variation was explained mostly by differences in overall health status.

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