Analysis Of Risk Factors Of Postoperative Fever After Flexible Ureteroscope Lithotripsy

Objective:To explore the risk factors of postoperative fever induced by flexible ureteroscope lithotripsy,so as to prevent postoperative fever and reduce the occurrence of fever progressing to sepsis and even septic shock.Method:The clinical data of 320 patients with upper urinary calculi who underwent ureteroscope lithotripsy in our hospital during 2 years from October 2020 to September 2022 were retrospectively analyzed,and 301 patients were screened out according to the inclusion and exclusion criteria.The basic information of patients,preoperative and intraoperative related indicators were counted,and the patients were divided into fever group and control group according to postoperative fever,and the clinical data of the two groups of patients were analyzed.The risk factors of postoperative fever were statistically analyzed,and the risk factors with statistical significance were analyzed by multivariate logistic regression to find out the independent risk factors of fever after flexible ureteroscope lithotripsy.Result:A total of 301 patients met the inclusion and exclusion criteria among 320 patients.Among the 301 patients,107(35.6%)were females,194(64.4%)were males,145(48.2%)were ≥55 years old,156(51.8%)were < 55 years old.A total of 24(8.0%)patients developed fever after surgery and were included in the fever group,while 277 patients without fever were included in the control group.Among the 24 patients with fever,5(1.7%)patients developed sepsis and 2(0.7%)patients developed septic shock.After treatment,they recovered and were discharged successfully.Five(1.7%)of the 301 patients with isolated kidney successfully completed lithotripsy without postoperative fever.Thirty-six(12.0%)patients underwent bilateral flexible ureteroscope lithotripsy at the same time,and 3(8.3%)patients developed fever after surgery.48(16.0%)patients had indentured ureteral stents before surgery,15(5.0%)patients had indentured nephrostomy tube before surgery,141(46.8%)patients had indentured nephrostomy tube before surgery,12(4.0%)patients had indentured ureteral stents before surgery,and 12(4.0%)patients had indentured nephrostomy tube before surgery.The midstream urine culture of 19 patients(6.3%)was positive before surgery,of which 10(52.6%)were Escherichia coli,and 1 patient had Serratia liquefaciens and Klebsiella pneumoniae.In the fever group,7 patients(29.2%)had positive urine culture before surgery.In univariate analysis,urinary white blood cell count(P < 0.001),urinary leukocyte enzyme activity(P < 0.05),urinary nitrite activity(P < 0.05),positive urine culture(P < 0.05),stone location(P=0.003),maximum stone diameter(P=0.001),Operative time(P < 0.001)was associated with fever after soft lithotripsy.Multivariate logistic regression analysis showed that operation time ≥60 minutes(P=0.012,OR=4.457,95%CI: 1.390～14.292).Nitrite activity in urine(P=0.003,OR=6.600,95%CI: 1.861-23.298);Urinary white blood cell count > 200/ul(P=0.023,OR=3.081,95%CI: 1.169～8.119)was an independent risk factor for fever after ureteral soft lithotripsy.Conclusion:Urinary white blood cell count > 200/ul,urinary nitrite activity,and operative time ≥60 minutes are independent risk factors for postoperative fever after ureteroscopy.Patients with fever within 48 hours after surgery should be treated as soon as possible to prevent further aggravation of infection and progression to sepsis or even septic shock,so as to alleviate the pain of patients.For patients with risk factors,preoperative adequate treatment,if necessary,after infection control,elective surgery or staging surgery.