POST OPERATIVE INFECTIVE COMPLICATIONS OF PCNL

Abstract

Background: Large and difficult kidney stones are best treated with percutaneous nephrolithotomy (PCNL). Postoperative infectious complications, including fever, urinary tract infection (UTI), pyelonephritis, systemic inflammatory response syndrome (SIRS), and sepsis, remain to be major causes of morbidity with its high stone clearance rate. Early identification of patients at risk will improve surgical results. Readmission was evaluated for the postoperative infective complication of PCNL. Objective: To evaluate the postoperative infective complication of PCNL. Methodology: This was an observational cross sectional study conducted over a period of four months in the Mayo Hospital in Lahore. The adult PCNL patients included were sampled using purposive sampling to achieve a sample size of 78. Those with a positive urine culture and/or fever prior to surgery were not included. A systematic questionnaire was used to gather the data, and SPSS version 26 was used for analysis. The relationship between postoperative fever and risk factors was determined using Chi square and Fisher's exact tests, and descriptive statistics were used to describe the patients' characteristics. Those with a p-value < 0.05 were considered to be statistically significant. Results.: The average age of the 78 patients in this study was 48 years. Men made up the majority (77%), and procedures on the right side were somewhat more common (56%). The most common complaint, occurring in almost 95% of cases, was flank pain. Staghorn stones were present in about one-third of the patients, and multiple calculi were discovered in 28%. Sixty percent of the individuals had hydronephrosis. Tractsizesweresplitequallybetweenthoseunderandover22Fr, and the majority (86%) only had one puncture. In 42% of cases, operations took more than 90 minutes, and 13% of patients had residual stones. Fever was the most common complication, impacting 36% of patients. More serious conditions like pyelonephritis and sepsis were much less common, occurring in only 6% and 5% of cases, respectively, while UTIs came in at 22%. When we looked at what caused these complications, we discovered that the likelihood of getting a fever was greatly increased by surgeries that lasted longer than 90 minutes, leftover stone fragments, a history of previous UTIs, previous episodes of urosepsis, and prior surgical interventions. In a similar manner, patients with a history of urosepsis, prolonged operations, or residual stones were more likely to experience UTIs. Pyelonephritis was closely associated with the presence of staghorn stones, a history of urosepsis, and a previous UTI. A history of urosepsis or UTI was most strongly linked to sepsis, despite its rarity. Gender, surgical side, diabetes, hypertension, stone location, hydronephrosis, and the use of stents or nephrostomy tubes were among the other factors we looked at, but they had no discernible effect on these results. Conclusion: Fever is the most common intra-post-operative complication after PCNL. Long operating time, diabetes mellitus, positive preoperative urine, staghorn calculi and multiple kidney stones are associated with a high risk of postoperative infection. A careful preoperative evaluation, a condition management, adequate antibiotic prophylaxis and surgical precision may help to minimize infectious complications and optimize patient outcomes