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Video: PCNL practice and outcomes in England

Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database

James N. Armitage, John Withington*, Jan van der Meulen*, David A. Cromwell*, Jonathan Glass, William G. Finch§, Stuart O. Irving§ and Neil A. Burgess§

Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, *Clinical Effectiveness Unit, The Royal College of Surgeons of England, Department of Urology, Guy’s & St Thomas’ NHS Foundation Trust, London School of Hygiene and Tropical Medicine, London, and §Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK


• To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals.


• We extracted records from the Hospital Episode Statistics (HES) database for all patients undergoing PCNL between March 2006 and January 2011 in English NHS hospitals.

• Outcome measures were haemorrhage, infection within the index admission, and rates of emergency readmission and in-hospital mortality within 30 days of surgery.


• A total of 5750 index PCNL procedures were performed in 165 hospitals.

• During the index admission, haemorrhage was recorded in 81 patients (1.4%), 192 patients (3.8%) had a urinary tract infection (UTI), 95 patients (1.7%) had fever, and 41 patients (0.7%) had sepsis.

• There were 595 emergency readmissions in 518 patients (9.0%). Reasons for readmission were varied: 70 (1.2%) with UTI, 15 (0.3%) sepsis, 73 (1.3%) haematuria, 25 (0.4%) haemorrhage, and 25 (0.4%) acute urinary retention.

• There were 13 (0.2%) in-hospital deaths within 30 days of surgery.


• Haemorrhage and infection represent relatively common and potentially severe complications of PCNL.

• Mortality is extremely rare after PCNL (about one in 400 procedures overall) but almost one in 10 patients have an unplanned hospital readmission within 30 days of surgery.

• Complications of PCNL may be under-reported in the HES database and need to be corroborated using other data sources.


1 reply
  1. Nick Rukin
    Nick Rukin says:

    Nice study. I agree with the idea of comparing BAUS PCNL data with the HES data directly. The results would be interesting and I suspect there would be some major discrepancy between them!
    One issue I have is regarding post op complications been coded correctly. Indeed, I wonder how many coders would pick up on post op fever, as in my practice I feel the rate of post op fever is much higher than the HES data demonstrates.
    I wonder if the 1 in 10 readmission rate may be partly explained by post op stent removals and antegrade studies.
    Enjoyed the video explanation of the study. Good work and it shows how useful HES data can be if used and interpreted correctly.

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