title: Postpercutaneous Nephrolithotomy Systemic Inflammatory Response Syndrome Is Not Associated With Unplanned Readmission.
abstract: 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 2 dedicated endourologic practices between 2009 and 2013. We collected patient demographics, perioperative culture data, and operative characteristics. SIRS was defined as having 2 or more of the following: maximum white blood cell count >12,000 or <4000, temperature >38 or <34°C, heart rate >90, and respiratory rate >20 within the first 24 hours following PCNL. Proportions between groups were compared to identify significant associations.
  
  
  
  We identified 389 patients undergoing PCNL and 43% (167 of 389) met SIRS criteria, more commonly in patients with multiple PCNL accesses (OR 2.3; CI: 1.1-4.8, P = .025). Readmission was required in 8% (31 of 389), most commonly for infection (n = 21). Although possession of a struvite stone was associated with unplanned readmission (16% vs 4%, P < .01), SIRS in the absence of fever within 48 hours postoperative was not associated with readmission (29.4% vs 25.8%, P = .837).
  
  
  
  Nearly half of the patients undergoing PCNL met the 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.
authors.affiliation: Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH. Electronic address: rachel.a.moses@hitchcock.org.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Moses
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agarwal
authors.affiliation: Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Raffin
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Boyd R
authors.initials: BR
authors.lastname: Viers
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Vidit
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.affiliation: Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Pais
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors