MP96-20 CHALLENGING THE PARADIGM OF MANDATORY OVERNIGHT OBSERVATION AFTER ELECTIVE PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2017MP96-20 CHALLENGING THE PARADIGM OF MANDATORY OVERNIGHT OBSERVATION AFTER ELECTIVE PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT Jennifer Robles and Nicole Miller Jennifer RoblesJennifer Robles More articles by this author and Nicole MillerNicole Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3043AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The typical paradigm for patients who undergo elective percutaneous nephrostomy tube placement (PCN) is 23-hr observation to monitor for post-procedure complications such as sepsis or bleeding. However, many similar Interventional Radiology (IR) procedures such as biopsies or abscess drainage are done on an outpatient basis. This maximizes patient and provider satisfaction while reducing medical costs and resource utilization. Our objective is to evaluate the safety of elective PCN placement and to identify which groups should be considered for outpatient PCN placement. METHODS We performed a retrospective chart review of 374 patients at our institution who underwent PCN or nephroureteral tube placement by IR from 1/2014 - 1/2016. We excluded inpatients, patients with suspected urosepsis, pregnancy, age <18 yrs or pelvic kidneys. All patients were admitted for observation. We collected data on demographics, clinical characteristics, procedural details and post-PCN clinical course. T-test and Chi-squared analysis were used to assess risk factors for statistical significance. RESULTS We identified 94 patients who underwent electively scheduled PCN placement (see Table 1). There were no major (Clavien Gr III-IV) complications, episodes of sepsis or hemorrhage. There were 8 patients (9%) with systemic inflammatory response syndrome (SIRS): tachycardia (6), fevers (5) and chills (2). Excluding a patient with pancytopenia due to chemotherapy, 100% of patients with SIRS had stones, 6/7 had staghorn stones (p=0.001) and 5/7 had been treated for positive cultures pre-PCN. They were also statistically more likely to have had difficult procedures & positive PCN cultures. Neither chronically colonized or purulent-appearing urine were associated with complications. CONCLUSIONS Our data suggests that most patients do not require admission for observation after elective PCN placement. Risk factors for post-PCN complications include large stone burden, longer fluoroscopy time, and difficult PCN access. One-third of patients with staghorn stones developed SIRS and they accounted for the majority of complications despite pre-PCN antibiotic treatment, highlighting the importance of renal pelvic urine cultures and close post-procedural observation for this high-risk group. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1302 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jennifer Robles More articles by this author Nicole Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...