Analysis of factors affecting re-admission after retrograde intrarenal surgery for renal stone
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ORIGINAL ARTICLE
Analysis of factors affecting re‑admission after retrograde intrarenal surgery for renal stone Tae Jin Kim1 · In Jae Lee1 · Jung Keun Lee1 · Hak Min Lee1 · Chang Wook Jeong2 · Sung Kyu Hong1 · Seok‑Soo Byun1 · Jong Jin Oh1 Received: 16 June 2018 / Accepted: 24 September 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Purpose To investigate the factors associated with hospital readmission (HR) after retrograde intrarenal surgery (RIRS) among renal stone patients. Methods The study included patients who underwent RIRS from June 2011 to December 2017. Patients who were readmitted due to surgery-related complications were evaluated retrospectively. Patient demographics including age, medical comorbidity, body mass indices, ASA score, perioperative parameters and stone factors were compared with total cohorts. HR was defined as visits to the Emergency Room or unplanned admission within 30 days after discharge. The factors affecting HR rates were analyzed using uni- and multi-variate analyses. Results A total of 572 patients were enrolled into the study. The mean age was 57.6 ± 14.1 years and the mean stone diameter was 13.4 ± 6.2 mm. The mean complication rate was 6.1% and the median hospitalization time was 2.1 ± 3.4 days. HR occurred in 20 patients (3.5%). Compared to non-admission patients, readmitted patients had a higher rate of bilateral RIRS (20.0% vs 12.2%, p = 0.035), number of stones (4.65 vs 2.2, p = 0.041) and higher stone complexity score (4.15 vs 2.11, p = 0.003). Multivariate analysis showed bilateral RIRS (OR 1.091, p = 0.031) and stone complexity (OR 1.405, p = 0.003) were significant factors to predict re-admission after RIRS. Conclusion Patients with complex renal stones or those who underwent bilateral RIRS were more likely to have a higher rate of re-admission. Proper perioperative management to prevent complications should be planned based on these predictive factors. Keywords Retrograde intrarenal surgery · Hospital readmission · Renal stone · Risk factor Abbreviations ESWL Extracorporeal shock wave lithotripsy PCNL Percutaneous nephrolithotomy RIRS Retrograde intrarenal surgery SFR Stone-free rates HR Hospital readmission ER Emergency room S-ReSc Seoul National University Renal Stone Complexity score * Jong Jin Oh [email protected] 1
Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300, Gumi‑dong, Bundang‑gu, Seongnam, Gyeongi‑do 463‑707, Korea
Department of Urology, Seoul National University Hospital, Seoul, Korea
2
ASA American Society of Anesthesiologists BMI Body mass index OR Odds ratio URS Ureteroscopy UTI Urinary tract infection
Introduction The management of renal stones has radically evolved over the last years. Extracorporeal shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) were the preferred treatment modalities for renal calculi. However, due to the advances in endoscopic flexible technology, retrograde intrarenal surgery (RI
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