Introduction: To evaluate the effect of American Society of Anesthesiology (ASA) scores on percutaneous nephrolithotomy (PNL) outcomes. Materials and Methods: The records of 186 consecutive patients undergoing PNL procedures from 2006 to 2011 at a single institution were evaluated. Patients were divided into a low-risk group with a preoperative ASA of I or II and a high-risk group with ASA of III or IV. Postoperative complications were classified according to the modified Clavien classification system. Results and Conclusions: There were 140 cases in the low-risk and 46 cases in the high-risk groups. The mean operative time was 72 min (40–120 min) and 86 min (55–125 min) and the complication rates were 17.8 and 19.5% for the low- and high-risk groups, respectively. The average duration of nephrostomy tube drainage was 3.3 ± 1 and 4.2 ± 1.5 days for the low- and high-risk groups, respectively. Stone-free rates were 85 and 82% for the low- and high-risk groups, respectively. PNL can be safely performed in the ASA high-risk patient population.

Keywords:
American Society of Anesthesiologists’ scoring system, Clavien classification system, Percutaneous nephrolithotomy
1.
Menon M, Resnick MI: Urinary lithiasis: etiology, diagnosis, and medical management; in Walsh PC, et al (eds): Campbell’s Urology, ed 8. Philadelphia, Saunders, 2002, pp 3229–3239.
2.
Morris DS, Taub DA, Wei JT, et al: Regionalization of percutaneous nephrolithotomy: evidence for the increasing burden of care on tertiary centers. J Urol 2006;176:242–246.
3.
Srirangam SJ, Darling R, Stopford M, et al: Contemporary practice of percutaneous nephrolithotomy: a review of practice in a single region of the UK. Ann R Coll Surg Engl 2008;90:40–44.
4.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205–213.
5.
Kukreja R, Desai M, Patel S, et al: Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 2004;18:715–722.
6.
El-Husseiny T, Moraitis K, Maan Z, et al: Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia. J Endourol 2009;23:1603–1606.
7.
Ozturk E, Yilmazlar T: Factors affecting the mortality risk in elderly patients undergoing surgery. ANZ J Surg 2007;77:156–159.
8.
Ramakumar S, Segura JW: Renal calculi. Percutaneous management. Urol Clin North Am 2000;27:617–622.
9.
Yuruk E, Tefekli A, Sari E, et al: Does previous extracorporeal shock wave lithotripsy affect the performance and outcome of percutaneous nephrolithotomy? J Urol 2009;181:663–667.
10.
Michel MS, Rassweiler JJ: Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899–906.
11.
Tefekli A, Karadag M, Tepeler K, et al: Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol 2008;53:184.
12.
Patel SR, Haleblian GE, Pareek G: Percutaneous nephrolithotomy can be safely performed in the high-risk patient. Urology 2010;75:51–55.
13.
Guven S, Istanbulluoglu O, Ozturk A, et al: Percutaneous nephrolithotomy is highly efficient and safe in infants and children under 3 years of age. Urol Int 2010;85:455–460.
14.
Lojanapiwat B, Kitirattrakarn P: Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy. Urol Int 2011;86:448–452.
15.
Srivastava A, Gupta P, Chaturvedi S, Singh P, et al: Percutaneous nephrolithotomy in ectopically located kidneys and in patients with musculoskeletal deformities. Urol Int 2010;85:37–41.
16.
Wang Y, Jiang F, Wang Y, et al: Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 2012;88:307–310.
17.
Singh V, Sinha RJ, Sankhwar SN, Malik A: A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia. Urol Int 2011;87:293–298.
18.
El-Nahas AR, Shokeir AA, El-Assmy AM, et al: Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007;177:576–579.
19.
De la Rosette JJ, Zuazu JR, Tsakiris P, et al: Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 2008;180:2489–2493.
20.
Resorlu B, Kara C, Sahin E, Unsal A: Comparison of nephrostomy drainage types following percutaneous nephrolithotomy requiring multiple tracts: single tube versus multiple tubes versus tubules. Urol Int 2011;87:23–27.
21.
Shen P, Liu Y, Wang J: Nephrostomy tube-free versus nephrostomy tube for renal drainage after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Int 2012;88:298–306.
© 2012 S. Karger AG, Basel
2012
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