The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy

Abstract

This study was to evaluate the risk factors of infectious complications after percutaneous nephrolithotomy (PCNL) and build a prediction tool for postoperative complications based on the risk factors. A total of 110 male (67.1%) and 54 female (32.9%) patients who underwent PCNL for renal stones between 2010 and 2014 in our institute were included. A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS) and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27.4%) developed SIRS and fever was observed in 20 cases (12.2%). In multivariate analysis, stone size (odds ratio, OR = 1.471, p = 0.009) and urine white blood cell (WBC) (OR = 1.001, p = 0.007) were related to the development of SIRS. Stone size (OR = 1.644, p = 0.024), urine WBC (OR = 1.001, p = 0.002) and serum albumin (OR = 0.807, p = 0.021) were associated with postoperative fever. We concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever.

Prediction of Infectious Complications after Percutaneous Nephrolithotomy

“…In this study 28.9% developed SIRS in post-operative period. Similar results were seen in other studies 1,8,[10][11] while in the study in the Department of Urology of Mayo Clinic, it was observed in only 9% of patients. 5 Sepsis was seen in 6.2 % of patients which was similar to other results 4,[11][12] while Mayo clinic study showed low sepsis rates which was as low as 0.9 % .…”

“…11,13 The study conducted at Fudan University, China concluded stone size and abnormal urinalysis to be significantly associated with SIRS. 1 A Thai study found that preoperative urine culture, pelvic urine culture and stone culture were positively associated with post operative SIRS. 8 However, a Dutch study showed no relation between preoperative urine culture with post operative fever or SIRS.…”

Postoperative Fever

“…Yang et al, in their study on patient undergoing percutaneous nephrolithotomy (PCNL), observed that preoperative urine white blood corpuscles count and stone size were risk factors for both fever and systemic inflammatory response syndrome (SIRS). (20) Even though fever may cause diagnostic confusion (central fever vs infectious), maintenance of normothermia appears to be desirable therapeutic goal in managing patients with damaged or at-risk brain tissue. (21) Laboratory evidence is quite clear regarding the adverse effects of fever in terms not only of functional outcomes, but also histological and neurochemical injury in these cases.…”

Stimulation of kidneys’ adaptive capabilities in patients with urolithiasis

“…Инфекционно-воспалительные осложнения удлиняют сроки пребывания пациентов в стационаре и последующий реабилитационный период, увеличивают расходы на лечение. К наиболее распространенным послеоперационным осложнениям ЧПНЛТ наряду с пиелонефритом и проблемами, вызванными резидуальными камнями, относят фебрильную лихорадку (до 32,1 % случаев) [5].…”