The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis

Abstract

Infection is the most common complications of percutaneous nephrolithotomy (PCNL) in treating urinary calculi. However, the risk factors for developing infectious complications after surgery have not been clarified, and the predictive value of some factors is controversial. This study aimed to assess the risk factors for postoperative infectious complications of PCNL. We performed a systematic search of PubMed, Web of Science, Cochrane Library, and EMBASE to obtain studies reporting risk factors for postoperative infection complications after PCNL. In this review, demographic factors, laboratory test factors, and perioperative factors were evaluated. The odds ratio (OR) or mean difference (MD) with a 95% confidence interval (CI) was calculated to assess the risk factors. A total of 18 studies were included, with a total of 7161 study patients with a mean age of 46.4 to 55.5 years and an incidence of infectious complications after PCNL ranging from 2.4% to 40.4%. Twelve factors were identified as independent risk factors for post-PCNL infection complications (P < 0.05), female (OR = 1.60, 95% CI 1.23-2.07), positive urine culture (UC) (OR = 3.16, 95% CI 2.11-4.74), positive renal pelvis urine culture (RPUC) (OR = 5.81, 95% CI 1.75-19.32), positive stone culture (SC) (OR = 5.11, 95% CI 1.46-17.89), positive urine leukocyte (OR = 3.61, 95% CI 2.45-5.34), infected stones (OR = 7.00, 95% CI 1.27-38.55), elevated blood leukocyte (MD = 0.71, 95% CI 0.31-1.10), elevated neutrophil-to-lymphocyte ratio (NLR) (MD = 0.55, 95% CI 0.43-0.66), preoperative stenting (OR = 1.55, 95% CI 1.10-2.20), multiple puncture access (OR = 2.58, 95% CI 1.75-3.82), prolonged operative time (MD = 10 20, 95% CI 4.80-15.60), and postoperative residual stone (OR = 1.56, 95% CI 1.24-1.98). Female, UC positivity, RPUC positivity, SC positivity, urine leukocyte positivity, infected stones, elevated peripheral blood leukocytes, elevated NLR, preoperative stent implantation, multiple puncture channels, prolonged operation time, and postoperative residual stones were identified as independent risk factors for infection complications after PCNL.

Keywords: Infectious complications; Influence factors; Percutaneous nephrolithotomy; Sepsis; Systemic inflammatory response syndrome; Urinary tract infection.

Fig. 1

PubMed search strategy

Fig. 2

Flow diagram of study selection

Fig. 3

Forest plot of demographic factors. (a) Infectious complications in female and male. (b) Infectious complications with and without diabetes. (c) BMI difference in patients with and without infectious complication. (d) Age difference in patients with and without infectious complication. (e) Infectious complications with and without hypertension

Fig. 4

Forest plot of laboratory testing factors. (f) Infectious complications of positive and negative urine cultures. (g) Infectious complications of positive and negative renal pelvis urine culture. (h) Infectious complications of positive and negative stone culture. (i) Infectious complications of positive and negative urine leukocyte. (j) Infectious complications with and without infected stones. (k) Blood leukocyte difference in patients with and without infectious complication. (l) Neutrophil-to-lymphocyte ratio difference in patients with and without infectious complication. (m) Platelet-to-lymphocyte ratio difference in patients with and without infectious complication. (n) Creatinine difference in patients with and without infectious complication

Fig. 5

Forest plot of perioperative factors. (o) Infectious complications of with and without staghorn stone. (p) Infectious complications of with and without preoperative stent placement. (q) Infectious complications of with and without blood transfusion. (r) Infectious complications of multiple and single access number. (s) Operative time difference in patients with and without infectious complication. (t) Infectious complications of with and without residual stone. (u) Stone size difference in patients with and without infectious complication. (v) Infectious complications of with and without hydronephrosis

Fig. 6

Bias analysis results of risk factors related to infectious complications