Risk Factors for Postoperative Fever and Systemic Inflammatory Response Syndrome After Ureteroscopy for Stone Disease

Southern, Jordan B.; Higgins, Andrew M.; Young, Amanda; Kost, Korey A.; Schreiter, Brielle; Clifton, Marisa M.; Fulmer, Brant R.; Garg, Tullika

doi:10.1089/end.2018.0789

Cited by 53 publications

(50 citation statements)

References 25 publications

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“…Strategies such as prophylactic antibiotics, limiting stent dwell or procedural time and staging procedures were identified as possible preventative measures. Similar parameters were identified by Southern et al [13], who retrospectively analysed 3298 patients undergoing URSL for stone disease and found that 7% of them developed post-operative SIRS/febrile UTIs. In their multivariate logistic regression, the authors found that female gender, surgical time and positive preoperative urine culture were predictors for infectious complications.…”

Section: Risk Factors Of Post-ureteroscopic Urosepsis From Previous Published Literaturesupporting

confidence: 77%

A Machine Learning Predictive Model for Post-Ureteroscopy Urosepsis Needing Intensive Care Unit Admission: A Case–Control YAU Endourology Study from Nine European Centres

Pietropaolo

Geraghty

Veeratterapillay

et al. 2021

JCM

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Introduction: With the rise in the use of ureteroscopy and laser stone lithotripsy (URSL), a proportionate increase in the risk of post-procedural urosepsis has also been observed. The aims of our paper were to analyse the predictors for severe urosepsis using a machine learning model (ML) in patients that needed intensive care unit (ICU) admission and to make comparisons with a matched cohort. Methods: A retrospective study was conducted across nine high-volume endourology European centres for all patients who underwent URSL and subsequently needed ICU admission for urosepsis (Group A). This was matched by patients with URSL without urosepsis (Group B). Statistical analysis was performed with ‘R statistical software’ using the ‘randomforests’ package. The data were segregated at random into a 70% training set and a 30% test set using the ‘sample’ command. A random forests ML model was then built with n = 300 trees, with the test set used for internal validation. Diagnostic accuracy statistics were generated using the ‘caret’ package. Results: A total of 114 patients were included (57 in each group) with a mean age of 60 ± 16 years and a male:female ratio of 1:1.19. The ML model correctly predicted risk of sepsis in 14/17 (82%) cases (Group A) and predicted those without urosepsis for 12/15 (80%) controls (Group B), whilst overall it also discriminated between the two groups predicting both those with and without sepsis. Our model accuracy was 81.3% (95%, CI: 63.7–92.8%), sensitivity = 0.80, specificity = 0.82 and area under the curve = 0.89. Predictive values most commonly accounting for nodal points in the trees were a large proximal stone location, long stent time, large stone size and long operative time. Conclusion: Urosepsis after endourological procedures remains one of the main reasons for ICU admission. Risk factors for urosepsis are reasonably accurately predicted by our innovative ML model. Focusing on these risk factors can allow one to create predictive strategies to minimise post-operative morbidity.

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Section: Risk Factors Of Post-ureteroscopic Urosepsis From Previous Published Literaturesupporting

confidence: 77%

A Machine Learning Predictive Model for Post-Ureteroscopy Urosepsis Needing Intensive Care Unit Admission: A Case–Control YAU Endourology Study from Nine European Centres

Pietropaolo

Geraghty

Veeratterapillay

et al. 2021

JCM

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“…A total of 2070 articles were initially identified, and 14 full-text English language articles were included in the final review which fit our inclusion criteria (Fig. 1) [13,15,[18][19][20][21][22][23][24][25][26][27][28]. The total number of ureteroscopies included in these papers was 24,373, and the mean age was 51.2 years (range 42-61 years), male:female ratio of 3:2 and a mean BMI of 26.9 (range 23.7-31.8) ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Antibiotic prophylaxis was practiced in most of the included studies and offers to reduce this risk [12]. It seems that there are several pre-disposing factors which increases this risk and includes positive pre-operative UTI or prior history of UTIs, patients with higher Charlson comorbidity index or elderly patients, female gender, presence and duration of indwelling ureteric stents, procedural time and patients with a neurogenic bladder and with high BMI [18][19][20][21][22][23][24][25][26][27][28]. Infectious complications vary from fever, urinary tract infection, pyelonephritis, systemic inflammatory response syndrome and urosepsis.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, there are many small, medium and highvolume prospective studies that have reported on the infectious complications following URS for renal stone disease [18][19][20][21][22][23][24][25][26][27][28][29]. Some studies have also looked at the risk factors for urinary infections following ureteroscopy and advised on strategies to reduce these risks.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

et al. 2020

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Purpose of Review To present the latest evidence related to the predictors of urinary tract infections (UTIs) and urosepsis after ureteroscopy (URS) for stone disease. Recent Findings Our review suggests that almost half of all post-URS complications are related to infectious complications although reported rates of urosepsis were low. The use of antibiotic prophylaxis, treatment of pre-operative UTI, and low procedural time seem to reduce this risk. However, the risk is higher in patients with higher Charlson comorbidity index, elderly patients, female gender, long duration of pre-procedural indwelling ureteric stents and patients with a neurogenic bladder and with high BMI. Summary Infectious complications following ureteroscopy can be a source of morbidity and potential mortality. Although majority of these are minor, efforts must be taken to minimise them especially in high-risk patients. This includes the use of prophylactic antibiotics, limiting stent dwell and procedural time, prompt identification and treatment of UTI and urosepsis, and careful planning in patients with large stone burden and multiple comorbidities.

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“…There are several modifiable and non-modifiable factors mentioned in the literature that may be used as predictors of SIRS. Higher SIRS rates were correlated with larger stone burden, surgical time, infectious stone, irrigation with an increased flow rate, small-caliber UAS, URS preceding after obstructive pyelonephritis, a positive PBUC, and female sex (7,8,13). Furthermore, history of previous urologic stone surgery, history of recurrent UTIs, preoperative pyuria, preoperative acute pyelonephritis, hydronephrosis, and the placement of a urethral catheter, DJS or percutaneous nephrostomy were recognized as factors increasing the risk for infectious complications in URS (14-17).…”

Section: Discussionmentioning

confidence: 98%

The effect of the duration between urine culture and semirigid ureteroscopic on the rate of systemic inflammatory response syndrome postoperatively

Akkaş¹,

Şam²,

Cinislioğlu³

et al. 2021

Preprint

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Purpose: The aim of this study is to analyze the preoperative and intraoperative factors that might induce systemic inflammatory response syndrome after semirigid ureteroscopic lithotripsy (SULL) , and to evaluate the impact of duration between preoperative bladder urine culture (PBUC) and surgery on postoperative systemic inflammatory response syndrome (SIRS). Methods: A retrospective review was conducted including patients who underwent SULL in our center between January 2011 and June 2020. Prior to surgery, PBUC were obtained from all patients and postoperatively patients were observed for signs of SIRS. Univariable and multivariable binary logistic regression analysis were implemented to demonstrate the factors that predict SIRS postoperatively. Results: The entire study included a cohort of 572 patients. The rate of SIRS following SULL was 1.7%. Predictive factors for SIRS were listed as stone volume, surgical time, and history of recurrent urinary tract infection. No significant difference was detected in terms of the duration between PBUC and SULL when comparing the SIRS group with the other group. Conclusion: The duration between PBUC and SULL is not an efficacious factor for SIRS. It may be useful to conduct prospective studies to enlighten this issues as endourologists deal with this duration dilemma often in daily practice. Keywords: Semirigid ureteroscopic lithotripsy, Systemic inflammatory response syndrome, Preoperative bladder urine culture

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Risk Factors for Postoperative Fever and Systemic Inflammatory Response Syndrome After Ureteroscopy for Stone Disease

Cited by 53 publications

References 25 publications

A Machine Learning Predictive Model for Post-Ureteroscopy Urosepsis Needing Intensive Care Unit Admission: A Case–Control YAU Endourology Study from Nine European Centres

A Machine Learning Predictive Model for Post-Ureteroscopy Urosepsis Needing Intensive Care Unit Admission: A Case–Control YAU Endourology Study from Nine European Centres

Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

The effect of the duration between urine culture and semirigid ureteroscopic on the rate of systemic inflammatory response syndrome postoperatively

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