Perioperative Complications and Risk Factors of Percutaneous Nephrolithotomy
Puttipannee Vorrakitpokatorn MD*, Krisana Permtongchuchai MD**, Em-Orn Raksamani BSc (Nursing)*, Anchana Phettongkam BSc (Nursing)*
Affiliation : * Department of Anesthesiology, Siriraj Hospital, Faculty of Medicine, Mahidol University ** Division of Anesthesiology, Potharam Hospital, Ratchaburi
Objective : To study the risk factors of perioperative complications of PerCutaneous NephroLithotomy (PCNL).
Materials and Methods : The present prospective descriptive study was carried out in the first time operation of
128 PCNL patients after general balanced anesthesia and standard surgical technique. Irrigation fluids
were 0.9% NSS (24.1 + 16.36 liters) at room temperature. Perioperative complications and risk factors were
observed, the results were displayed as adjusted Odds Ratio (OR), 95%CI and p value.
Results : Intraoperative complications were hypothermia (56.2%), cardiovascular changes (57.1%) and bleed-
ing. The first two complications statistically significantly related to volume of irrigation fluid > 20 liters (7.4,
p < 0.05). Postoperative complications were electrolyte changes (but not statistically significant), pleural
tear (3 cases), infection and bleeding. Septic shock was found in 4.7% (6/128) and 0.78% (1/128) died. Fever
was significantly correlated with postoperative transfusion > 1 unit (adjusted OR 4.9, p < 0.05). Risk factors
of postoperative bleeding were operation time (adjusted OR 4.4, p < 0.05), intraoperative transfusion
(adjusted OR 10, p < 0.01) and postoperative fever (adjusted OR 4.9 p < 0.01). Mean was 7.3 + 5.22 days
and the mode of Length Of Stay after operation (LOSPO) was 5 days. LOSPO was significantly related with
postoperative fever > 38.5 oC (adjusted OR 2.7, p < 0.05).
Conclusion : Volume of irrigation fluid at room temperature >20 liters significantly increased the rate of
intraoperative hypothermia and cardiovascular changes. Infection was the most serious complication of
PCNL and increased LOSPO. Antibiotics started at the beginning of the surgery could not always prevent this
event.
Keywords : Renal stone, Urolithiasis, PCNL, Irrigation fluid, Postoperative length of stay
