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Upper Tract Calculi and Associated Surgical Complications in Spina Bifida patients
HsinHsiao Wang*, Michael Lipkin, John Wiener, Sherry ross, Jonathan Routh, Durham, NC

INTRODUCTION AND OBJECTIVES: Risk of urolithiasis is thought to be higher in the spina bifida (SB) population. The management of urinary tract stones in SB patients is often challenging but poorly described in the literature. Our objective was to compare the treatment and related complications of urolithiasis interventions in SB patients to other stone formers through a national all ages database.

METHODS: We retrospectively reviewed the Nationwide Inpatient Sample (NIS) for admissions with renal and ureteral stones from 1998-2011. We used ICD-9-CM codes to identify urologic interventions [shockwave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), ureteral stent placement], and National Surgical Quality Improvement Program (NSQIP) post-operative complications. Elixhauser comorbidity score was extracted using comorbidity software. Logistic regression and negative binomial regression were performed.

RESULTS: We identified 4,287,529 stone admissions including 12,315 (0.3%) SB patient admissions. Compared with non-SB patients, SB patients with urolithiasis were significantly younger (mean 34 vs 53 years), less likely to have private insurance (24 vs 43%), more likely to have renal calculi (81 vs 58%), and to undergo PCNL (27 vs 8%). After adjusting for age, Elixhauser comorbidity scores, treatment year, surgery type, and stone location, SB patients were more likely to have urinary tract infections(OR 2.5, p<0.001), urinary complications(OR 3.2, p<0.001), acute renal failure(OR=2.0, p<0.001), respiratory complications(OR 2.0, p<0.001), pneumonia(OR 1.5, p=0.005), prolonged (>96hrs) mechanical ventilations(OR 3.2, p<0.001), sepsis(OR 2.6, p<0.001), pulmonary embolism(OR 3.1, p=0.030), cardiac complications(OR 2.5, p=0.02), post-op bleeding(OR 1.6, p=0.010), and longer length of stay (RR 1.6, p<0.001).

CONCLUSIONS: Compared with non-SB stone admissions, SB patients were younger, have a higher risk of renal stones, and are more likely to undergo PCNL. Urolithiasis procedures in SB patients were associated with significantly higher risk of immediate post-operative complications.

Source of Funding: none

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