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Factors associated to hemoglobin decrease after percutaneous nephrolithotomy: a retrospective study
Syarif Syarif1, Abdul Azis1, Saidah Rahmat A2
1Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar. syarifbakri@hotmail.com.
Insights
Older age, diabetes, and longer operation times increase the risk of hemoglobin decrease after percutaneous nephrolithotomy (PCNL). Intraoperative bleeding is also a significant factor in this common complication.
Area of Science:
- Urology
- Nephrology
- Surgical Risk Assessment
Background:
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
- Postoperative hemoglobin decrease is a frequent complication following PCNL.
- Identifying risk factors is crucial for patient management and optimizing surgical outcomes.
Purpose of the Study:
- To identify preoperative and perioperative risk parameters associated with a significant decrease in hemoglobin (Hb) after PCNL.
- To stratify patients based on the magnitude of Hb reduction to understand contributing factors.
Main Methods:
- Prospective data collection from 273 patients undergoing PCNL between January 2018 and December 2022.
- Patients were divided into two groups based on a 1.5 g/dl median decrease in postoperative Hb levels.
- Preoperative, stone, and perioperative factors were analyzed for association with Hb reduction.
Main Results:
- Older age (mean 55.48 vs 45.9 years) and higher intraoperative bleeding (mean 285.85 vs 135 ml) were observed in the group with greater Hb decrease.
- Longer operation times (mean 86.35 vs 64.89 min) were also significantly associated with greater Hb reduction.
- Multivariate analysis confirmed age, diabetes mellitus, intraoperative bleeding, and operation time as significant predictors of Hb decrease.
Conclusions:
- Advanced age, comorbid diabetes mellitus, substantial intraoperative bleeding, and prolonged operative duration are key risk factors for postoperative hemoglobin decrease after PCNL.
- These findings aid in preoperative risk assessment and patient counseling for PCNL procedures.
Objective:
This study aims to determine the preoperative and perioperative risk parameters associated with a decrease in hemoglobin (Hb) in patients undergoing percutaneous nephrolithotomy (PCNL).
Methods:
We collected prospective data of consecutive patients who underwent PCNL from January 2018 to December 2022. The median decrease in post-operative hemoglobin levels compared to pre-operative was found to be 1.5 g/dl. This value was the cut-off value that divided the sample into two groups. Group 1 has a decrease in Hb levels that is higher or equal to the cutoff, group 2 has a decrease in Hb levels that is lower than the cut-off. All preoperative, stone characteristics and perioperative factors were recorded.
Results:
A total of 273 patients were included in the study, 141 in Group 1 and 132 in Group 2. The mean age of Group 1 was significantly higher (55.48 ± 8.73 vs 45.9 ± 10.75 years, p < 0.05). The mean bleeding of Group 1 was significantly higher (285.85 ± 113.68 vs 135 ± 77.54 ml, p < 0.05). There was a significant difference in mean operation time between groups (86.35 ± 32.05 vs 64.89 ± 27.83 min, p < 0.05). Multivariate analysis showed that the variables age, comorbid diabetes mellitus, intraoperative bleeding amount, and operation time had a significant relationship with Hb reduction in patients undergoing PCNL (p < 0.05).
Conclusions:
Older age, comorbid diabetes mellitus, large amounts of intraoperative bleeding, and longer operating time are factors associated with PCNL-related postoperative hemoglobin decrease.
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