Finding a solution: preliminary results of percutaneous nephrolithotomy outcomes under saline-restricted irrigation...

In September 2024, flooding from Hurricane Helene shut down a Baxter Solutions facility, which produced ~ 60% of the United States' intravenous fluids, resulting in a nationwide saline shortage. Hospitals subsequently restricted perioperative irrigation, including in percutaneous nephrolithotomy (PCNL), which traditionally relies on continuous saline irrigation throughout the procedure. We compared outcomes of PCNL under saline-restricted conditions with matched cases performed before the shortage.

Between October 15 and November 4, 2024, ten PCNLs were performed with recommendations to minimize irrigation. A matched control group was selected from a prospective institutional PCNL database, matched by age, sex, stone size, and operative time. Perioperative and postoperative outcomes-including irrigation volume, stone-free rate, laboratory values, and hospital length of stay-were analyzed using t-tests, Pearson chi-square, and Fisher's exact tests.

Mean irrigation volume was significantly lower in the saline-restricted group compared with controls (6,600 ± 4,852 mL vs. 19,125 ± 18,195 mL, p = 0.009). There were no significant differences in baseline demographics, stone volume, or operative time. The saline-restricted group had a shorter hospital length of stay (0.9 ± 0.3 days vs. 1.8 ± 1.8, p = 0.0462), and lower postoperative day 1 creatinine (0.9 ± 0.3 mg/dL vs. 1.3 ± 0.5 mg/dL, p = 0.026). Postoperative hemoglobin, hematocrit, residual stone burden, and residual stone grades were similar between groups.

PCNL performed under saline-restriction significantly reduced irrigation volume without adversely affecting early postoperative outcomes or residual stone burden. These findings support judicious saline use during PCNL, particularly in times of supply shortage.