Statin Use and Risk of Sepsis After Percutaneous Nephrolithotomy.
OBJECTIVE
To examine the association between statin medication use and sepsis risk after percutaneous nephrolithotomy (PCNL).


METHODS
Using medical claims data, we identified working-age adults with urinary stone disease who were treated with PCNL. Among this cohort, we determined which patients had a prescription fill for a statin agent that encompassed their surgery date. We then fitted logistic regression models to examine for differences in rates of postoperative sepsis between statin users and nonusers. In addition, we evaluated the frequency of nonfebrile urinary tract infections (UTIs) and intensive care unit (ICU) services utilization and hospital length of stay (LOS) as a function of statin use.


RESULTS
During the study period, at total of 2046 patients underwent PCNL, 382 (18.7%) of whom had a prescription fill for a statin agent preceding their surgery. The overall rate of sepsis in this population was 3.8%. After adjusting for patient health status and sociodemographic factors, the rate of postoperative sepsis was comparable between statin users and nonusers (5.3% vs 3.5%, respectively; P=0.105). In addition, UTI and ICU utilization rates did not relate to statin use (P>0.05 for all associations). Adjusted hospital LOS was shorter among statin users, but the difference was clinically trivial (3.6 vs 4.1 days; P=0.007).


CONCLUSIONS
Statin use is not associated with reductions in postoperative sepsis, nonfebrile UTIs, ICU utilization, or hospital LOS after PCNL. To increase the safety of PCNL, urologists will have to consider other processes of care (e.g., clinical care pathways).
1 Department of Urology, Divisions of Endourology and Health Services Research, University of Michigan Medical School , Ann Arbor, Michigan.|2 Department of Surgery, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University (IMSIU) , Riyadh, Saudi Arabia .
Abdulrahman F
AF
Alruwaily
3 Department of Urology, Harvard Medical School , Boston, Massachusetts.
Brian H
BH
Eisner
1 Department of Urology, Divisions of Endourology and Health Services Research, University of Michigan Medical School , Ann Arbor, Michigan.
Maggie J
MJ
Bierlein
1 Department of Urology, Divisions of Endourology and Health Services Research, University of Michigan Medical School , Ann Arbor, Michigan.
Khurshid R
KR
Ghani
1 Department of Urology, Divisions of Endourology and Health Services Research, University of Michigan Medical School , Ann Arbor, Michigan.
J Stuart
JS
Wolf
1 Department of Urology, Divisions of Endourology and Health Services Research, University of Michigan Medical School , Ann Arbor, Michigan.
Brent K
BK
Hollenbeck
1 Department of Urology, Divisions of Endourology and Health Services Research, University of Michigan Medical School , Ann Arbor, Michigan.
John M
JM
Hollingsworth
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003422:Critical Care; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods*; D012044:Regression Analysis; D012306:Risk; D018805:Sepsis / Q000188:drug therapy* / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy; D014572:Urology / Q000379:methods; D055815:Young Adult
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors