Abstract: PD30-05
Sources of Funding: None

Introduction

Percutaneous nephrolithotomy (PCNL) is the standard of care for treatment of large renal stones. While complications associated with PCNL are uncommon, post-PCNL hemorrhage requiring blood transfusion is a common concern. We investigate risk factors for transfusion following PCNL using a prospectively collected database.

Methods

An institutional review board approved, prospectively maintained database of patients undergoing percutaneous nephrolithotomy was utilized for this investigation. All patients undergoing PCNL who received a blood transfusion in the post-operative period were included in this study. These patients were matched 1:1 for BMI and stone composition. A statistical analysis was performed utilizing student t-test and Fischer’s exact test for continuous and categorical variables, as well as stepwise multivariate logistic regression analysis to identify risk factors for blood transfusion.

Results

A total of 1448 patients were identified, of those, 49 (3.3%) received a blood transfusion in the post-operative period. Patients who received a blood transfusion were older (mean (SD) 60.7 (16) versus 53.5 (17) years, p=0.03), more likely to have: a bilateral procedure (67.7 versus 40.6%, p=0.02), a diagnosis of diabetes (73% versus 44%, p=0.03), paralysis/contractures (12.2% vs 0%, p<0.01) a lower pre-operative hemoglobin (12.6 (2.0) versus 13.6 (2.1) gm, p=0.01) and a longer primary procedure length (163.8 (57.0) versus 131.9 (48.5) min, p=0.01). On forward stepwise multivariate logistic regression analysis the presence of diabetes (OR 4.7, 95% CI 1.5 - 14.7, p=0.008) and bilateral procedure (OR 7.1, 95% CI 1.9-26.4, p=0.003) was significantly associated with receipt of a transfusion.

Conclusions

The overall transfusion rate within our patient population was low at 3.3%. However, patients with a pre-operative diagnosis of diabetes and those undergoing a bilateral procedure had an increased risk for a transfusion. Patients with diabetes and those undergoing a bilateral procedure should be counseled appropriately regarding the increased risk for bleeding related complications.

Funding

None