A nomogram predicting severe adverse events after ureteroscopic lithotripsy: 12 372 patients in a Japanese national series

What's known on the subject? and What does the study add? Ureteroscopic lithotripsy sometimes causes severe complications, e.g. septic shock, and the relationship between long operative duration and complication rate has been empirically recognised. But due to the rarity, evidence is limited. W...

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Bibliographic Details
Published in:BJU international 2013-03, Vol.111 (3), p.459-466
Main Authors: Sugihara, Toru, Yasunaga, Hideo, Horiguchi, Hiromasa, Nishimatsu, Hiroaki, Kume, Haruki, Ohe, Kazuhiko, Matsuda, Shinya, Fushimi, Kiyohide, Homma, Yukio
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
complications
Female
Humans
lithotripsy
Lithotripsy - adverse effects
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
nomogram
Nomograms
Postoperative Complications - epidemiology
Risk Factors
Time Factors
Treatment Outcome
ureteroscopy
Ureteroscopy - adverse effects
Urinary lithiasis
urolithiasis
Urolithiasis - therapy
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Summary:What's known on the subject? and What does the study add? Ureteroscopic lithotripsy sometimes causes severe complications, e.g. septic shock, and the relationship between long operative duration and complication rate has been empirically recognised. But due to the rarity, evidence is limited. We analysed 12372 cases and showed that the complication rate increased according to operative duration, especially for operations taking >90 min. Also, we found that high‐volume centres had lower complication rates. Objective To develop a nomogram to predict severe adverse events (AEs) after ureteroscopic lithotripsy (URSL) including the effects of operative duration and hospital volume. Patients and Methods We identified patients undergoing URSL from the Japanese Diagnosis Procedure Combination database between 2007 and 2010, and defined severe adverse events as (i) in‐hospital mortality; (ii) postoperative medication including catecholamine, γ globulin, protease inhibitors, medications for disseminated intravascular coagulation and transfusion; and (iii) postoperative interventions including percutaneous nephrostomy, central vein catheterisation, intensive care unit, dialysis, mechanical cardiopulmonary support. Univariate and multivariate logistic regression models addressed the occurrence of severe AEs. Results Of 12 372 patients, 296 patients (2.39%) had severe AEs. Multivariate analysis showed a positive linear trend of operative duration and severe AEs (odds ratio [OR] 1.58 in 90–119 min to OR 4.28 in ≥210 min compared with ≤ 59 min; each P 
ISSN:1464-4096
1464-410X
DOI:10.1111/j.1464-410X.2012.11594.x