The effect of the American Society of Anesthesiology classification scores on complications associated with percutaneous nephrolithotomy

Kısa, Erdem; Yücel, Cem; Budak, Salih; Uçar, Murat; Keskın, Mehmet; Çakmak, Özgür; Koç, Gökhan; Kozacıoğlu, Zafer

doi:10.4081/aiua.2018.2.112

Cited by 4 publications

(3 citation statements)

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“…Ancak daha az morbiditeye neden olan RİRC de tekrarlayan seanslarla benzer başarıyı sağlayabilmektedir (3,4). PNL'nin daha fazla komplikasyona ve morbiditeye neden olduğunu belirten çalışmalar olduğu gibi Amerikan Anesteziyoloji Derneği skoru ASA-3 olan riskli hastalarda bile güvenle uygulanabileceğini bildiren çalışmalar da literatürde bulunmaktadır (3,(5)(6)(7) (12). Çalışmamızda da hem primer hem sekonder hasta grubunda yükseköğrenim almış grup sadece yaklaşık %15'lik dilimi oluşturmaktadır.…”

Section: Discussionunclassified

Üriner Sistem Taşlarında Önceki Müdahalelerin Preoperatif Faktörlere ve Postoperatif Sonuçlara Etkisi: İki Merkezli Analiz

et al. 2020

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Bu çalışmada üriner sistem taşı olup müdahale öyküsü bulunanlarla primer hastaların preoperatif ve peri-operatif sonuçlarını karşılaştırmayı amaçladık. Gereç ve Yöntemler: Lokal etik kurul onayı alındıktan sonra Ekim 2018-Ocak 2019 tarihlerinde her iki merkezde üriner sistem taşı nedeniyle ameliyat edilen hastalar içerisinden şok dalga litotripsi veya taş cerrahisi öyküsü olmayan 152 primer hasta Grup 1, müdahale öyküsü olan 232 hasta ise Grup 2 olarak çalışmaya alındı. Bulgular: Demografik özellikler iki grupta benzer bulundu. Düşük sosyoekonomik düzey ve düşük eğitim düzeyi olanlar büyük çoğunluğu oluşturmaktaydı. Son 1 yılda yapılan BT görüntüleme sayısı sekonder hastalarda istatistiksel olarak daha fazlaydı (p<0,001). Grup I'de üreter taşları çoğunluğu oluşturmaktayken; Grup 2'de böbrek taşları istatistiksel olarak daha fazlaydı. Taş sayısı primer hastalarda daha düşüktü (p<0,001). Uygulanan baskın prosedür Grup 1'de ureterorenoskopi (URS), Grup 2'de retrograd intrarenal cerrahiydi (RİRC) (p<0,001). Primer hastaların başarı oranı daha yüksek bulundu (p=0,015). Postoperatif medikal tedavi verilenler sekonder hastalarda daha yüksek bulundu (p<0,001). Her iki grup arasında beslenme ve fiziksel aktivite alışkanlığı alışkanlıkları açısından istatistiksel farklılık gözlenmezken; sigara kullananlar Grup 2'de daha yüksek orandaydı (sırasıyla %44,1,%52,2, p=0,044). Sonuç: Üriner sistem taş hastalarının yaklaşık yarısı hayatları boyunca tekrar nüks etmektedir. Sekonder olan bu grupta taş sayısı ve rezidüel fragman kalma ihtimali daha yüksek bulundu. Taşların yerleşimi de sekonder grupta sıklıkla böbrekte olduğu için başarı göreceli olarak daha az bulundu. Taş protokollü bilgisayarlı tomografinin ve postoperatif medikal tedavinin sekonder hastalarda kullanımı daha fazla bulundu. Daha önce taş öyküsü bulunmasının bu konuda etkili olduğunu düşünmekteyiz. Sonuç olarak, sekonder taş hastalarının yönetimi daha zorlu görünmektedir.

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Section: Discussionunclassified

Üriner Sistem Taşlarında Önceki Müdahalelerin Preoperatif Faktörlere ve Postoperatif Sonuçlara Etkisi: İki Merkezli Analiz

et al. 2020

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“…Even in the elderly, the fact that grade III-IV complications are below 3% reinforces this situation. Most complications in elderly patients with high comorbidity and anesthesia risk, as in young people, are based on the Grade I-II of classification of modified the Clavien and/or Grade I-II of the Satava system [19-21]. The multivariate logistic regression analysis of demonstrating factors predicting complications showed that the presence of residual stone and operation time are the most crucial factor in the elderly group.…”

Section: Discussionmentioning

confidence: 99%

Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different in Non-elderly Adults?

Çakıcı¹,

Sarı²,

Selmï³

et al. 2019

Cureus

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Background and objectives The population of elderly adults is increasing globally, and due to metabolic changes related to advanced age, many elderly adults experience kidney stones. Flexible ureteroscopy (f-URS) is a minimally invasive procedure to treat kidney stones, but it is not free of complications. The goals of this study were to analyze the efficacy and safety of f-URS in the management of kidney stones in patients aged ≥60 years and compare the outcomes of this surgery with the outcomes of the same surgery in a younger population. Materials and methods We retrospectively reviewed patient data from 1750 patients who met our inclusion criteria and received f-URS at the urology clinic of our hospital from 2012 to 2017. Patients were assigned into two groups: those aged ≥60 years (Group 1, n=291) and those aged 19-59 years (Group 2, n=1459). The perioperative results were evaluated comparatively. We performed multivariable analyses for factors predicting complications. Results When we compared the groups on demographic attributes, we noted statistically significant differences in gender, body mass index (BMI), and American Society of Anesthesiologists scores. Stone size and operation time were higher in the ≥60-year age group (Group 1). Other stone characteristics and operative features were similar. Stone-free rates (SFR) after the first procedure were 88.0% in Group 1 and 89.2% in Group 2. SFR and success rates at three months were similar for both groups. The complication rates were similar, and multivariable regression analysis revealed the most important factor affecting the complications was the presence of residual stones in both groups. The second most important factor affecting the complication was the operation time in Group 1 and the number of stones in Group 2. Conclusion In our study, there were no significant differences in terms of results and complications among elderly and young patients after f-URS except for the duration of the operation. The prolongation of operation time results in worse outcomes in terms of perioperative complications in patients aged ≥60 years. f-URS is a relatively safe and efficient procedure, with a small risk of minor complications even in the elderly population, with increased comorbidity.

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“…This system could be used to choose the type of anesthesia and to assess the tolerance of patients to various surgical manipulations such as surgical position. Staying in a prone position during PCNL could lead to some difficulties, such as those in controlling the airway and maintaining the vascular access and ventilation of patients with lung diseases ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Performing percutaneous nephrolithotomy under modified local anesthesia

Liu

et al. 2022

Front. Surg.

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ObjectiveThis pilot study aimed to assess the practicability and effectiveness of percutaneous nephrolithotomy (PCNL) with vacuum-assisted nephrostomy sheaths for patients under modified local anesthesia (m-LA).MethodsPCNL with a vacuum-assisted nephrostomy sheath under m-LA was performed in 83 patients between November 2020 and May 2021. An 18F or 20F ClearPetra Nephrostomy Sheath connected vacuum aspiration was used in surgery to keep low pressure in the renal pelvis. For LA, lidocaine and ropivacaine hydrochloride were 1:1 mixed and instilled under ultrasound guidance through the percutaneous nephrolithotomy channel directed toward the design calix. Demographic characteristics, stone characteristics, visual analogue scale (VAS) score, vital signs, operation time, complications, and stone clear rate were recorded and analyzed.ResultsAll operations were completed. The mean VAS score was 3.9 ± 1.0. The mean operation time was 55.1 ± 23.6 min. The changes for systolic blood pressure, diastolic blood pressure, and heart rate were 3 ± 21 mmHg, 1 ± 14 mmHg, and −6 ± 14 beats/min, respectively. The change for hemoglobin was −10.7 ± 10.9 g/L. The change for C-reactive protein was 5.39 ± 43.1 mg/L. The total stone-free rate was 69.9% (93.8% for simple stones and 54.9% for complex stones).ConclusionPerforming PCNL with vacuum-assisted nephrostomy sheaths under modified local anesthesia under ultrasound guidance was found to be strongly practical and effective.

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The effect of the American Society of Anesthesiology classification scores on complications associated with percutaneous nephrolithotomy

Abstract: We believe that PCNL operation can be performed effectively and safely in both ASA3 patients and patients above the age of 65 years.

Cited by 4 publications

References 20 publications

Üriner Sistem Taşlarında Önceki Müdahalelerin Preoperatif Faktörlere ve Postoperatif Sonuçlara Etkisi: İki Merkezli Analiz

Üriner Sistem Taşlarında Önceki Müdahalelerin Preoperatif Faktörlere ve Postoperatif Sonuçlara Etkisi: İki Merkezli Analiz

Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different in Non-elderly Adults?

Performing percutaneous nephrolithotomy under modified local anesthesia

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