Presentation Authors: Stuart Irving*, William Finch, Norwich, United Kingdom, Daron Smith, Sarah Fowler, John Withington, London, United Kingdom, Oliver Wiseman, Cambridge, United Kingdom
Introduction: Percutaneous nephrolithotomy (PCNL) is routinely utilized in the management of large renal stones and staghorn calculi. PCNL is more efficacious when compared to other treatment modalities but carries an increased risk of morbidity. Sepsis is a known complication of PCNL with Significant associated morbidity. We sought to describe procedural and patient risk factors for blood transfusion using a national prospective data registry.
Methods: Surgeon reported data submitted to the British Association of Urological Surgeons PCNL data registry between 2011 and 2017 was analyzed for reported rates of sepsis. We assessed risk factors for sepsis, including sex, age, BMI, comorbidity, previous infections and their management, pre-existing tubes, pre op work up, induction antibiotics, stone complexity defined by Guys Stone Score (I-II versus III-IV) and patient position (prone versus supine).
Results: Of the 11673 PCNL procedures reported sepsis was seen in 2.5%. Significant differences were seen with higher reported rates of sepsis in female patients, the over 70â€™s, patients with significant comorbidity, a previous history of urinary tract infections, pure or mixed growth on pre-operative MSU and more complex stone scores. There was no difference in the post-operative sepsis rates seen in obese patients, prophylactic induction antibiotic use, operative patient position, or existence of a pre-existing catheter or nephrostomy tube.
Conclusions: Higher risk of post-operative sepsis can be identified in older female patients, patients with a prior history of urinary tract infections, a pre-operative MSU showing a pure growth or the presence of mixed growth. Failure to use induction antibiotics, indwelling catheters or nephrostomy tubes or patient position for surgery did not in our series increase the risk of post-operative sepsis.