Risk factors for pulmonary complications after percutaneous nephrolithotomy

Kim

et al. 2019

JCM

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP.

Section: Discussionsupporting

confidence: 92%

Incidence and Risk Factors of Pulmonary Complications after Robot-Assisted Laparoscopic Prostatectomy: A Retrospective Observational Analysis of 2208 Patients at a Large Single Center

Kim

et al. 2019

JCM

“…However, our previous studies demonstrated that male sex, older age, and high body mass index were independent risk factors of PPCs in robot-assisted laparoscopic prostatectomy, percutaneous nephrolithotomy, and laparoscopic pylorus-preserving pancreaticoduodenectomy. 7 , 8 , 56 These differences in independent risk factors for PPCs may be, at least in part, explained by differences in the patient characteristics and the type of surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 2 – 5 In particular, postoperative pulmonary complications (PPCs) are associated with prolonged hospital stays and increased cost. 6 – 8 Therefore, careful management is necessary to prevent PPCs in radical cystectomy.…”

mentioning

confidence: 99%

Impact of Prognostic Nutritional Index on Postoperative Pulmonary Complications in Radical Cystectomy: A Propensity Score-Matched Analysis

Hong

et al. 2020

Ann Surg Oncol

Self Cite

Background Radical cystectomy is a standard treatment for muscle-invasive bladder cancer but frequently entails postoperative pulmonary complications (PPCs). Nutrition is closely associated with postoperative outcomes. Therefore, we evaluated the impact of preoperative prognostic nutritional index (PNI) on PPCs in radical cystectomy. Methods PNI was calculated as 10 × (serum albumin) + 0.005 × (total lymphocyte count). The risk factors for PPCs were evaluated using multivariate logistic regression analysis. A receiver operating characteristic curve analysis of PNI was performed, and an optimal cut-off value was identified. Propensity score-matched analysis was used to determine the impact of PNI on PPCs. Postoperative outcomes were also evaluated. Results PPCs occurred in 112 (13.6%) of 822 patients. Multivariate logistic regression analysis identified PNI, age, and serum creatinine level as risk factors. The area under the receiver operating characteristic curve of PNI for predicting PPCs was 0.714 (optimal cut-off value: 45). After propensity score matching, the incidence of PPCs in the PNI ≤ 45 group was significantly higher compared with the PNI > 45 group (20.8% vs. 6.8%; p < 0.001), and PNI ≤ 45 was associated with a higher incidence of PPCs (odds ratio 3.308, 95% confidence interval 1.779–6.151; p < 0.001). The rates of intensive care unit admission and prolonged (> 2 days) stay thereof were higher in patients who developed PPCs. Conclusions Preoperative PNI ≤ 45 was associated with a higher incidence of PPCs in radical cystectomy, suggesting that PNI provides useful information regarding pulmonary complications after radical cystectomy.

“…[ 1 – 3 ] Nevertheless, PNL-related postoperative complications have been reported, including renal hemorrhage, colonic or pleural injury, postoperative pulmonary complications, and septicemia. [ 4 , 5 ] Hence, meticulous anesthetic and surgical management is required during PNL.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for acute kidney injury after percutaneous nephrolithotomy

Yu¹,

Kwon³

et al. 2018

Medicine

Self Cite

Percutaneous nephrolithotomy (PNL) is a minimally invasive technique for renal stone removal but can cause renal parenchymal injury. Renal stones can also affect renal function. We evaluated the risk factors for acute kidney injury (AKI) after PNL.The study cohort included 662 patients who underwent PNL. Patient characteristics, preoperative laboratory values, intraoperative data, and stone characteristics were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AKI after PNL. Postoperative outcomes such as hospitalization, intensive care unit admission rate and stay duration, and chronic kidney disease were also evaluated.Of the total study series, there were 107 (16.2%) cases of AKI after PNL (AKI group), and 555 (83.8%) patients who showed no injury (no-AKI group). The risk factors for AKI after PNL were found to be a higher preoperative serum uric acid level [odds ratio (OR) = 1.228; 95% confidence interval (95% CI) = 1.065–1.415; P = .005], longer operation time (OR = 1.009; 95% CI = 1.004–1.014; P < .001), and intraoperative hypotension (OR = 12.713; 95% CI = 7.762–20.823; P < .001). Hospitalization and intensive care unit stay duration were significantly longer in the AKI group (8.7 ± 5.2 vs 6.6 ± 2.8 days, P < .001; 0.34 ± 1.74 vs 0.07 ± 0.48 days, P = .002, respectively). Chronic kidney disease was also significantly higher in the AKI group (63.6% vs 32.7%, P = .024).As intraoperative hypotension is an important risk factor for AKI after PNL, which leads to poor postoperative outcomes, it should be prevented or managed vigorously during PNL.