Predicting Complications in Supine Mini-Percutaneous Nephrolithotomy: The Role of the E-PASS Scoring System

To evaluate the predictability of postoperative complications in patients undergoing supine mini-percutaneous nephrolithotomy (mPNL) using the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system. The study investigated whether the E-PASS scoring system could serve as an objective criterion for identifying patients at high risk of complications. The ultimate goal was to enhance postoperative patient management and minimize complications.

The data of 224 patients who underwent supine mPNL in our clinic between April 2017 and July 2024 were retrospectively analyzed. Postoperative complications were assessed according to the modified Clavien-Dindo classification.

Postoperative complications were observed in 31 (13.8%) of the 224 patients included in the study. While there were no significant differences between the groups in terms of age, sex, or body mass index, the complication group had a higher American Society of Anesthesiologists score (p = 0.007) and a higher Eastern Cooperative Oncology Group performance score (p = 0.001). Furthermore, the complication group exhibited greater blood loss (p = 0.001) and a longer hospital stay (p = 0.017). Comprehensive risk score (CRS) was identified as an independent predictor of postoperative complications (odds ratio: 7.481, 95% confidence interval: 3.054-18.322; p = 0.001). The area under the curve in the receiver operating characteristic curve analysis for CRS was calculated to be 0.862.

The E-PASS scoring system was found to be successful in predicting complications following supine mPNL. A CRS value exceeding 0.862 was associated with an increased risk of severe complications. Therefore, it is recommended that less invasive surgical options be considered for patients with high CRS values.