Perioperative Complications in Percutaneous Nephrolithotomy: Predictive Risk Factors and Hemodynamic Alterations

Area of Science:

• Urology
• Nephrology
• Surgical Outcomes

Background:

• Percutaneous nephrolithotomy (PCNL) is a primary treatment for large kidney stones.
• Perioperative hemodynamic changes and influencing factors in PCNL are understudied.
• Fluctuations in vital signs and electrolytes during PCNL can lead to complications.

Purpose of the Study:

• To analyze vital sign variations during PCNL.
• To identify factors influencing patient condition, hypothermia, and blood transfusion needs.
• To describe hemodynamic and biochemical changes in the perioperative period of PCNL.

Main Methods:

• 134 patients undergoing PCNL were monitored.
• Systolic blood pressure, diastolic blood pressure, temperature, hemoglobin, hematocrit, sodium, and potassium were assessed preoperatively, during, and 24 hours post-surgery.
• Logistic regression analyzed factors like BMI, surgery duration, irrigation volume, tracts, blood loss, hypothermia, and transfusion requirements.

Main Results:

• Mean arterial pressure decreased during PCNL.
• Patient temperature decreased, with a slight rise towards the end of surgery.
• Hemoglobin, hematocrit, and sodium levels declined post-surgery.
• Irrigation fluid volume predicted mild hypothermia.
• Longer surgery, more tracts, and poorer patient condition correlated with increased blood transfusion needs, but not Hb loss.

Conclusions:

• Vital sign variability (airway, breathing, circulation) is typical before and after PCNL.
• Hypothermia is linked to irrigation fluid volume.
• Transfusions are mainly needed in complicated cases and critical patient states.
• Identifying modifiable factors can improve clinical outcomes in PCNL.