To investigate the incidence of Systemic Inflammatory Response Syndrome (SIRS) following Percutaneous Nephrolithotomy (PCNL ) and evaluate any association with unplanned 90 day readmission.
We retrospectively reviewed consecutive patients undergoing PCNL in two dedicated endourologic practices between 2009 and 2013. We collected patient demographics, perioperative culture data, and operative characteristics. SIRS was defined as having two or more of the following: maximum white blood cell count >12,000 or <4,000, temperature>38or<34 degrees Celsius, heart rate >90, and respiratory rate >20 within the first 24hrs following PCNL. Proportions between groups were compared to identify significant associations.
We identified 389 patients undergoing PCNL and 43%(167/389) met SIRS criteria, more commonly in patients with multiple PCNL accesses (OR2.3;CI:1.1-4.8,p=0.025). Readmission was required in 8%(31/389), most commonly for infection (n=21). Although possession of a struvite stone was associated with unplanned readmission (16%vs.4%,p<0.01), SIRS in the absence of fever within 48hrs post op was not associated with readmission (29.4% vs 25.8%, p=0.837).
Nearly half of patients undergoing PCNL met criteria for SIRS within the first postoperative day. There was no association between SIRS and unplanned readmission in the postoperative PCNL patient. Despite discharge during the first postoperative day, patients with SIRS (without fever or struvite stones) had no increased risk for unplanned return. Our findings suggest that the development of SIRS immediately following PCNL does not preclude safe discharge on the first postoperative day.
Urology. 2016 Sep 15 [Epub ahead of print]
Rachel Moses, Deepak Agarwal, Eric Raffin, Boyd Viers, Vidit Sharma, Amy Krambeck, Vernon Pais
Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH. Electronic address: ., Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH., Department of Urology, Mayo Clinic, Rochester, MN.