A nomogram predicting severe adverse events after ureteroscopic lithotripsy: 12 372 patients in a Japanese national series

作者：Sugihara Toru^*; Yasunaga Hideo; Horiguchi Hiromasa; Nishimatsu Hiroaki; Kume Haruki; Ohe Kazuhiko; Matsuda Shinya; Fushimi Kiyohide; Homma Yukio

来源：BJU International, 2013, 111(3): 459-466.

DOI：10.1111/j.1464-410X.2012.11594.x

• complications
• lithotripsy
• nomogram
• ureteroscopy
• urolithiasis

Objective %26lt;br%26gt;To develop a nomogram to predict severe adverse events (AEs) after ureteroscopic lithotripsy (URSL) including the effects of operative duration and hospital volume. %26lt;br%26gt;Patients and Methods %26lt;br%26gt;We identified patients undergoing URSL from the Japanese Diagnosis Procedure Combination database between 2007 and 2010, and defined severe adverse events as (i) in-hospital mortality; (ii) postoperative medication including catecholamine, gamma globulin, protease inhibitors, medications for disseminated intravascular coagulation and transfusion; and (iii) postoperative interventions including percutaneous nephrostomy, central vein catheterisation, intensive care unit, dialysis, mechanical cardiopulmonary support. %26lt;br%26gt;Univariate and multivariate logistic regression models addressed the occurrence of severe AEs. %26lt;br%26gt;Results %26lt;br%26gt;Of 12 372 patients, 296 patients (2.39%) had severe AEs. Multivariate analysis showed a positive linear trend of operative duration and severe AEs (odds ratio [ OR] 1.58 in 90-119 min to OR 4.28 in %26gt;= 210 min compared with %26lt;= 59 min; each P %26lt; 0.05) and an inverse relationship between hospital volume and severe AEs (OR 0.64 in %26gt;= 39 URSLs/year compared with %26lt;= 15 URSLs/year; P = 0.004) with adjustment for other significant factors including sex, age, Charlson comorbidity index, type of anaesthesia and type of admission. %26lt;br%26gt;A nomogram and a calibration plot based on these results were well-fitted to predict a probability between 0.01 and 0.10 (concordance index 0.677). %26lt;br%26gt;Conclusion %26lt;br%26gt;Severe AEs after URSL were associated with longer operative duration and lower hospital volume, and were accurately predicted using the present nomogram.

• 出版日期2013-3