Abstract: PD16-05
Sources of Funding: None

Introduction

Despite antibiotics, sepsis remains the most common cause of perioperative mortality after percutaneous nephrolithotomy (PCNL). There have been numerous studies investigating risk factors for the development of post-operative infection in PCNL patients. Herein, we describe our meta-analysis of the risk factors for the prediction of post-PCNL infectious complications.

Methods

The electronic databases were searched using a combination of the terms "percutaneous nephrolithotomy", "risk factors", "infection", and "sepsis." The primary outcome was post-PCNL infection as defined by fever >38°C or sepsis as defined by the Sepsis Consensus Definition Committee. Risk factors for infection in each study were identified and included for analysis if present in at least 2 studies. We used quantitative effect sizes in odds ratio to assess each endpoint. Outcomes were pooled using the inverse variance technique with random-effects models.

Results

After application of criteria, 24 studies were found, of which 12 were prospective and 12 were retrospective. Of the 12 prospective studies, pre-operative urine culture, renal pelvis culture, stone culture, number of access points, hydronephrosis, perioperative blood transfusion and struvite stone composition were found to be significantly associated with post-operative infection. Of the 12 retrospective studies pre-operative urine culture, stone cultures, number of access points, blood transfusion, stone size and staghorn formation were significantly associated with infection. _x000D_ _x000D_

Conclusions

In both prospective and retrospective studies, pre-operative urine culture, stone culture, number of access points and need for blood transfusion were found to be significant factors. This indicates that the presence of bacteria in the urine/stone pre-operatively as well as the amount of trauma the kidney sustains during the procedure are predictors of post-operative infection. We believe that this is the first meta analysis to identify these risk factors.

Funding

None