Presentation Authors: Toru Sugihara*, Shimotsuke, Japan, Hideo Yasunaga, Hiroki Matsui, Tokyo, Japan, Yusuke Sasabuchi, Shimotsuke, Japan, Haruki Kume, Tokyo, Japan, Tetsuya Fujimura, Shimotsuke, Japan
Introduction: Immobility was a risk of urinary stone formation. In the advanced ageing society, a number of long-term bed-rest patients was increasing. Because a bedridden patient was usually in a frail status, surgical risk for them would be higher than that of more well-being patients.In this study, we evaluated perioperative risk of ureterorenoscopic lithotoripsy (URSL) among bedridden elderly using the Japanese nationwide administrative claims database; the Diagnosis Procedure Combination (DPC) database.
Methods: Based on the database, we extracted cases with surgical code of URSL (a Japanese original code, K781) between April 2014 and March 2016. Degree of bedridden was judged based on the Barthal ADL (activity of daily living) index. Walking ability was measured as follow; Grade 0, independent; Grade 1, partially supported; Grade 2, wheel chair, Grade 3, disable. The main outcome was severe adverse event including mortality and shock status. Multivariate analysis for the outcome was performed adjusting with age, sex, comorbidity, and dementia level.
Results: Finally, 6492 URSL cases were included in the study. Overall severe adverse event was 2.1%. Severe adverse event occurred in 1.3%, 2.4%, 2.5% and 4.0% in terms of the walking ability Grade 0, 1, 2, and 3. (p < 0.01). The similar results in multivariable logistic regression analyses were confirmed. (p < 0.01). Severe comorbidity and dementia were also significantly associated risk factors for severe adverse event.
Conclusions: In conclusion, bedridden status was significantly associated with risk of severe adverse event after URSL. Patients and family would be recommended to be informed of the risk to make decision for treatment of upper urinary tract calculi.Limitation: retrospective database analysis.
Source of Funding: The study has been financially supported by grants from the Japanese Ministry of Health, Labour and Welfare (H29-Policy-Designated-009 and H29-ICT-Genral-004).