Reasons for early readmission after percutaneous nephrolithotomy and retrograde intrarenal surgery.

Abstract

Introduction Hospital readmissions are frequent and costly. In many countries health governors focus on unplanned postsurgical hospital readmissions as an objective metric for quality of care. Aim To investigate the rate of readmissions after retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) operations, classify these factors, define the higher risk patients for readmission and develop prevention strategies. Material and methods A historical cohort study was conducted for a period of 36 months, between 2013 and 2016. A total of 471 consecutive patients, of whom 177 had PCNL (37.6%) and the remaining 294 had RIRS (62.4%), were included. The two groups were compared in terms of stone burden, previous stone treatments, initial symptoms, ASA class, intra-operative complications, post-operative stenting, and drugs prescribed at discharge, so as to find the factors influencing the readmission rate for both groups. Results The PCNL operation was found to have a significantly higher risk for readmission when compared to RIRS (27.1% vs. 20.4%, respectively, p = 0.0041). Perioperative complications (p = 0.002 for PCNL and p = 0.001 for RIRS), residual stone(s) or fragments after the operation (p = 0.002 for PCNL and p = 0.001 for RIRS) significantly increased the readmission rate in both groups. The readmission rates were individually affected by postoperative JJ stent placement in the PCNL group (p = 0.001) and previous stone treatments for the RIRS group (p = 0.001). Conclusions Readmission rates were higher in the PCNL group, but the influencing factors were similar for both groups. The presence of multiple stones preoperatively and residual stones or fragments postoperatively are the most important risk factors for early re-admission after PCNL and RIRS.

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

“…This finding demonstrates that a large cluster of care apps may enhance clinical outcomes in patients and provide complete care. Current clinical nursing care, guided by the “patient-centered” philosophy, is concerned not only with the patient's physical recovery but also with his or her emotional and psychological well-being, with the intention of improving the patient's functions by active intervention [ 24 – 26 ]. The study patients after PCNL cluster of nursing care can be an effective combination of caring elements, a relatively routine care can improve the quality of life to a greater extent, and high patient satisfaction degree.…”

Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy

“…Previous stone surgery was another risk factor. Similarly, Keskin analyzed 417 patients undergoing urinary surgery and found that readmission rates were significantly higher in patients with previous stone treatments than in patients with no history of stone treatments ( 9 ). Patients with a history of previous stone surgery are also at an increased risk of stone recurrence after another subsequent stone procedure (except for second stage surgery), likely because they are already recurrent stone formers.…”

“…However, the latest studies have demonstrated that in some patients, small residual fragments or even CIRF are not expelled spontaneously after surgery and can lead to stone-related symptoms, including infection, hematuria, and back pain, and may require surgical treatment (6)(7)(8)(9). In addition, the probability of stone growth in patients with upper urinary tract stones after surgery is 10% within 1 year, 35% within 5 years, and up to 50% within 10 years (10,11).…”