Risk Factors for Postoperative Fever and Systemic Inflammatory Response Syndrome After Ureteroscopy for Stone Disease
INTRODUCTION 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.
MATERIALS & METHODS 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.
RESULTS 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.
CONCLUSIONS 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.