Urosepsis and fever after laser lithotripsy procedures in a single Australian institution

Abstract

Objective: To identify predictive and modifiable risk factors associated with fever and urosepsis in the post-operative period of ureteropyeloscopy and laser lithotripsy procedures for urolithiasis. Materials and methods: Records from 284 consecutive adult patients undergoing laser lithotripsy at John Hunter Hospital, Australia (2013–2017) were retrospectively reviewed. A wide variety of demographics, results, anaesthetic and operative data were compared between those who developed infectious complications (defined as fever ⩾38 or sepsis from a urinary source) and those who did not. Results: In total, 372 cases of Holmium:YAG laser lithotripsy were included. Despite excellent antibiotic prophylaxis rates, 10.2% ( n=38) of patients developed infectious complications (81.6% within 24 hrs). Urosepsis cases were twice as likely to have a positive pre-operative urine culture ( p=0.0148) and nearly four times as likely to have mixed growth ( p=0.0001). The proportion of smokers was twice as high in the infectious complication group (42.1%, p=0.0017), as was incomplete stone clearance (31.6% compared to 12.3%, p=0.0013), and female patients were twice as likely to develop an infectious complication as men (16.7% of all female cases, 7.1% of all male cases). Conclusion: Infectious complications post laser lithotripsy remain common in the Australian setting. Positive pre-operative urine culture, current smoking status, incomplete stone clearance and female gender were identified as significant risk factors. We propose high-risk patients should be monitored in the post-operative period with a low threshold for extending antibiotic therapy and every opportunity taken for smoking cessation counselling. Level of evidence: 3a (according to Oxford centre for evidence-based medicine)