Presented by: Brian H Eisner MD
Massachusetts General Hospital

Introduction

Percutaneous nephrolithotomy is one of the most common procedures to treat large kidney and upper ureteric stones. Although there have been improvements in the procedure technique, there is still a risk of severe infectious complications. Urosepsis and septic shock correlated to percutaneous nephrostomy have an incidence of 0.3-4.7%. However, the mortality rates of these patients can be as high as 80%. This study aims to determine possible risk factors for post-intervention sepsis.

Materials

With prior IRB approval data was gathered prospectively at multiple participating centers of patients undergoing PCNL. Data was analyzed in SPSS v 25. Continuous data was assessed for normality of distribution using the Kolmogorov-Smirnov test. Single logistic regressions were performed for associated variables to establish their possible relation with positive quick Sequential Organ Failure Assessment status(qSOFA) after the intervention. Models were assessed with Omnibus’ test of model coefficients as well as Hosmer and Lemeshow’s test of model fit. Results are presented in Odds Ratios(OR) with 95% confidence intervals(CI).

Results

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A total of 320 patients were analyzed. Of these, 23 met qSOFA criteria after the intervention, suggesting a 7.18% rate of postoperative sepsis. Of analyzed variables, the ones found to have significant ORs for developing +qSOFA were: High ASA Score(4-5), Positive Preoperative Urine Culture and Underlying Renal Anatomic Abnormalities such as horseshoe kidneys. Table 1 displays odds ratios for these variables.

Conclusion

Higher comorbidity scores, positive cultures as well as renal anatomic abnormalities may be significant predictors of infectious complications after elective PCNL. These findings should be validated in external cohorts.

Funding

No funding

Co-Authors

Juliana Villanueva, MD, MPH
Columbia

Michal Segall, MD
Massachusetts General Hospital