Perioperative complications and risk factors of percutaneous nephrolithotomy.
OBJECTIVE
To study the risk factors of perioperative complications of PerCutaneous NephroLithotomy (PCNL).


METHODS
The present prospective descriptive study was carried out in the first time operation of 128 PCNL patients after general balanced anesthesia and standard surgical technique. Irrigation fluids were 0.9% NSS (24.1 +/- 16.36 liters) at room temperature. Perioperative complications and risk factors were observed, the results were displayed as adjusted Odds Ratio (OR), 95%CI and p value.


RESULTS
Intraoperative complications were hypothermia (56.2%), cardiovascular changes (57.1%) and bleeding. The first two complications statistically significantly related to volume of irrigation fluid > 20 liters (7.4, p < 0.05). Postoperative complications were electrolyte changes (but not statistically significant), pleural tear (3 cases), infection and bleeding. Septic shock was found in 4.7% (6/128) and 0.78% (1/128) died. Fever was significantly correlated with postoperative transfusion > or = 1 unit (adjusted OR 4.9, p < 0.05). Risk factors of postoperative bleeding were operation time (adjusted OR 4.4, p < 0.05), intraoperative transfusion (adjusted OR 10, p < 0.01) and postoperative fever (adjusted OR 4.9 p < 0.01). Mean was 7.3 +/- 5.22 days and the mode of Length Of Stay after operation (LOS(PO)) was 5 days. LOS(PO) was significantly related with postoperative fever > 38.5 degrees C (adjusted OR 2.7, p < 0.05).


CONCLUSIONS
Volume of irrigation fluid at room temperature >20 liters significantly increased the rate of intraoperative hypothermia and cardiovascular changes. Infection was the most serious complication of PCNL and increased LOS(PO). Antibiotics started at the beginning of the surgery could not always prevent this event.
Vorrakitpokatorn
Puttipannee
P
Department of Anesthesiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
Permtongchuchai
Krisana
K
Raksamani
Em-Orn
EO
Phettongkam
Anchana
A
D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D007507:Therapeutic Irrigation; D016896:Treatment Outcome