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The Effect of Marital Status on Post-Operative Outcomes after PCNL
Jacqueline M. Speed, MD1, Alexander P. Cole, MD1, Jerilyn M. Latini, MD2, Tyler R. McClintock, MD, MS1, Ye Wang, PhD1, Steven L. Chang, MD, MS1, Ruslan Korets, MD2.
1Brigham and Women's Hospital, Boston, MA, USA, 2Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, MA, USA.

BACKGROUND:
Married patients with cancer have been shown to have improved overall survival, earlier stage at diagnosis, and improved adherence to treatment compared to their unmarried counterparts. Proposed reasons for this include that married patients have better support systems and easier access to care. Patients with nephrolithiasis who are recovering from a surgical procedure may see a similar benefit by being married. The aim of this study is to evaluate if marital status is associated with improved outcomes including complications, costs, and length of stay for a percutaneous nephrolithotomy (PCNL), a common non-oncologic urologic procedure.
METHODS:
We utilized the Premier Healthcare Database, a national hospital discharge database, which collects data from over 700 non-federal US hospitals, representing approximately 20% of all hospitalizations, to identify patients who underwent PCNL between 2003-2015. Patients were stratified as either married or not married. We examined patient demographics, Charlson comorbidity index, postoperative complications, length of stay (LOS), and direct hospital costs, as well as hospital and surgeon characteristics. Univariate logistic regression analysis and a median regression of costs were done in addition to a multivariable regression analysis adjusting for potential confounders.
RESULTS:
Between 2003 and 2015, we identified 19,976 patients who underwent PCNL. Of the examined cohort, 50.7% of patients were categorized as married. On univariate analysis, we found a 38.8% shorter LOS, 35% decrease in major complications, and $425.93 decrease in total direct costs of admission for married patients compared to unmarried patients. On multivariate analysis, married men were noted to have the shortest LOS, with married women, unmarried men, and unmarried women staying longer (OR 1.35, 1.45, and 1.65, respectively, all p<0.0001). Married patients were also less likely to have a major complication (OR 0.82, p=0.025).
CONCLUSIONS:
While marital status is known to be associated with improved survival in cancer patients, it also appears to be associated with improved post-operative outcomes including a shorter LOS in married men and lower rate of major complications in married patients undergoing PCNL. Reasons for this require further investigation but may be related to better familial support in the postoperative period.


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