Objectives
To evaluate the impact of body mass index (BMI) on clinical outcomes and costs associated
with percutaneous nephrostolithotomy (PCNL).
Methods
We reviewed charts of 200 consecutive patients who underwent PCNL between September
2005 and May 2007. We recorded patient and stone characteristics and perioperative
outcomes. BMI was available for 150 patients (75%), who comprised our study group.
We obtained direct and subcomponent costs (room and board, laboratory, pharmacy, radiology,
operating room, surgical supplies, anesthesia, and recovery room). We divided patients
into four BMI categories: normal weight (BMI < 25), overweight (25 ≤ BMI < 30), obese
(30 ≤ BMI < 40), and morbidly obese (BMI ≥ 40). We compared groups with regard to
baseline characteristics, intraoperative parameters, stone-free and complication rates,
and hospital length of stay.
Results
Mean stone size and proportion of patients with staghorn, multiple, and bilateral
calculi were similar among groups. The normal weight cohort had proportionately fewer
recurrent stone formers and patients with a history of stone surgery, compared with
the other groups (P = .005 and P = .03, respectively). We found no significant differences among groups with regard
to stone-free and complication rates, operative time, length of stay, or need for
multiple accesses. Median direct cost was marginally, but not significantly, higher
in normal weight ($8124) compared with overweight ($6746), obese ($6740), and morbidly
obese ($6719) patients (P = .75).
Conclusions
Body mass index had no impact on efficacy or complication rates of PCNL. Despite greater
perceived difficulty in performing these procedures in overweight and obese patients,
it was not more costly.
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Article info
Publication history
Published online: August 21, 2008
Accepted:
June 30,
2008
Received:
April 28,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
