Surgical Delay Increases the Perioperative Blood Transfusion Rate In Percutaneous Nephrolithotomy

We aimed to investigate the effect of prolonged time from diagnosis to treatment (TDT) on surgical outcomes in patients undergoing percutaneous nephrolithotomy (PNL).

This study included a total of 544 patients who underwent PNL in our clinic between November 2017 and November 2021. Clinicodemographical, radiological, and perioperative data of the patients were recorded. The stone-free rate as assessed by abdominal computed tomography at 3 months was estimated. The possible relation of the stone-free rate and perioperative complications with TDT was examined.

The median age was 48 (range, 38-58) years, the median stone size was 405 (range, 250-700) mm², and the median stone density was 1,000 (range, 730-1,221) Hounsfield units. The median TDT was 75 (range, 42-133) days. Twenty-seven patients (5.0%) required perioperative blood transfusion (PBT). There was a statistically significant correlation between TDT and the need for PBT (p=0.022). However, there was no significant correlation between TDT and stone-free rate (p>0.05). Using a cutoff value of 90.5 days, TDT could predict the need for PBT with 59.3% sensitivity and 60% specificity.

Our study results suggest that the need for PBT increases in patients undergoing PNL longer than 90.5 days after the diagnosis. However, further large-scale, prospective studies are warranted to elucidate the effect of prolonged TDT on surgical outcomes in this patient population.