Outcomes of percutaneous nephrolithotomy in spinal cord injury patients as compared to a matched cohort

Spinal cord injury patients are at increased risk of developing nephrolithiasis and may require percutaneous nephrolithotomy for treatment of large stone burdens. Our objective was to compare outcomes of PCNL in SCI patients as compared to a matched cohort of non-SCI patients. Data from the Healthcare Cost and Utilization Project State Inpatient Database for Florida and California were used to identify patients by ICD-9 codes who underwent PCNL between 2007 and 2011. SCI was identified by having a paralysis diagnosis on the chronic comorbidity indicator. One-to-one matching was performed based on age, race, gender, presence of preoperative UTI, and major comorbidities. Of the 39,868 unique patients identified, who underwent PCNL, 1918 (4.81%) were SCI patients. After matching, worse perioperative outcomes in SCI patients were demonstrated. SCI patients had significantly longer length of stay, higher rates of sepsis, and increased minor and moderate complications (p < 0.001). Multivariate analysis demonstrated an independently increased risk of mortality, minor and major complications, pneumonia, sepsis, and length of stay in SCI patients. PCNL in SCI patients is associated with a high complication rate and longer hospital stay even when controlling for presence of preoperative UTI and medical comorbidities. To our knowledge, this is the first study of outcomes of PCNL in a large population of SCI patients. These patients represent a high risk population and strategies to decrease complications need to be developed and implemented.