Infectious complications following ureteroscopy for stone disease lead to emergency department visits, hospitalizations, and other costly healthcare utilization. The objective of our study was to identify risk factors for post-operative fever (POF) and systemic inflammatory response syndrome (SIRS) after ureteroscopy (URS) for stone disease.
We performed a retrospective cohort study on 2746 patients who underwent 3298 URS for stone disease at Geisinger from 2008-2016. A univariate analysis tested the associations between candidate demographic, preoperative, and intraoperative predictors and the primary outcome of POF (temperature >100.4F) or SIRS. Variables with a p value <0.05 on univariate comparisons were entered into a random effects logistic regression model. The final model used backwards elimination random effects logistic regression to identify predictors most predictive of POF/SIRS.
Overall 229 (6.9%) of 3298 URS had POF/SIRS. On univariate analysis, individuals with POF/SIRS were older, had higher mean body mass index, higher Charlson comorbidity index (CCI), bilateral and larger stones, stone location in the kidney, positive preoperative urine culture, pre-stented, and had longer surgical times. In the final model, female gender (adjusted OR 1.6, 95% CI 1.19-2.15), surgical time (adjusted OR 1.01, 95% CI 1.0-1.01), CCI ≥2 (adjusted OR 1.86, 95% CI 1.29-2.67), and positive preoperative urine culture (adjusted OR 1.53, 95% CI 1.06-2.22) were the most significant predictors of POF/SIRS.
Female gender, longer surgical time, medical complexity, and positive preoperative urine culture are associated with POF/SIRS after URS. These data may be used to identify and counsel high-risk individuals.
Journal of endourology. 2018 Dec 20 [Epub ahead of print]
Jordan B Southern, Andrew M Higgins, Amanda J Young, Korey A Kost, Brielle Schreiter, Marisa Clifton, Brant Fulmer, Tullika Garg
Geisinger Health System, 2780, Urology, Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Urology, Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Biostatistics Core, Biomedical & Translational Informatics Institute, Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Phenomic Analytics & Clinical Data Core, Biomedical & Translational Informatics Institute, , Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Urology, Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Urology, Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Urology, Danville, Pennsylvania, United States ; ., Geisinger Health System, 2780, Urology , 100 N. Academy Avenue , Danville, Pennsylvania, United States , 17822-2101 ; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/30569755
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