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Predictive Value of Stone Management According to Size-Hardness (SMASH) Score for Post-Operative Fever after
Rıdvan Kayar1, Kemal Kayar1, Emrah Özsoy2
1Department of Urology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Surgical Infections
|July 31, 2025
Summary
The Stone Management According to Size-Hardness (SMASH) score can predict post-operative fever after ureteroscopy (URS). Higher SMASH scores, longer operative times, and proximal stone location indicate increased risk for fever following URS.
Area of Science:
- Urology
- Infectious Complications
- Medical Imaging
Background:
- Post-operative fever (POF) is a frequent complication after ureteroscopy (URS).
- Identifying patients at high risk for POF is crucial for optimizing peri-operative care and reducing morbidity.
- The Stone Management According to Size-Hardness (SMASH) score is a composite index assessing stone characteristics.
Purpose of the Study:
- To evaluate the predictive capability of the SMASH score for forecasting POF after URS.
- To identify key predictors of POF in patients undergoing URS for ureteral stones.
Main Methods:
- Retrospective analysis of 143 patients undergoing URS for unilateral ureteral stones.
- Data collected included SMASH score, Hounsfield unit (HU) values, stone size and location, operative time, and hydronephrosis.
- POF defined as temperature ≥38.3°C with positive urine culture; statistical analyses included comparative and ROC curve assessments.
Main Results:
- POF occurred in 11.9% of patients.
- Higher SMASH scores (median 8.08 vs. 5.09), HU values (720 vs. 626), and longer operative times (41 vs. 34 min) were significantly associated with POF.
- Proximal stone location was also more prevalent in patients with POF.
Conclusions:
- Elevated SMASH scores, prolonged operative time, and proximal stone location are independent predictors of POF post-URS.
- The SMASH score shows promise as a tool for pre-operative risk stratification.
- Enhanced peri-operative precautions can be implemented for high-risk patients identified by the SMASH score.
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