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| The global, prevalence, and risk factors of postoperative fever after percutaneous nephrolithotomy: A systematic review and meta-analysis |
Reza Falahatkara,Siavash Falahatkara,Mohammad Amin Khajavi Gaskareia,Masoomeh Afzalipoorb,Ali Mojtahedic,Neda Aligolighasemabadid,Ahmad Deilamia,Samaneh Mirzaei Dahkae,Mohammad-Hossein Keivanloua,Alireza Jafaria,*( )
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aUrology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
bDepartment of Surgery, University of Saskatchewan, Saskatoon, Canada
cMicrobiology Department, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
dDepartment of Internal Medicine, School of Medicine, Guilan University of Medical Siences, Rasht, Iran
eSchool of Nursing and Midwifery, Guilan University of Medical Sciences, Guilan, Rasht, Iran |
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Abstract Objective: This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis. Methods: The high-sensitivity searching was conducted without time limitation until December 30, 2020 in Web of Sciences, Scopus, and PubMed based on inclusion and exclusion criteria. Results: The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5% (95% confidence interval [CI]: 9.3%-9.7%), and 4.5% (95% CI: 4.2%-4.8%), respectively. Nephrostomy tube was used in 9.96% (95% CI: 9.94%-9.97%) of patients. The mean preoperative white blood cells of patients were 6.401×109/L; 18.3% and 4.55% of patients were considered as the positive urinary culture and pyuria, respectively. About 20.4% of patients suffered from residual stones. The odds ratios (ORs) of fever in patients who suffering from diabetes mellitus, hydronephrosis, staghorn stones, and blood transfusion were 4.62 (95% CI: 2.95-7.26), 1.04 (95% CI: 0.81-1.34), 2.57 (95% CI: 0.93-7.11), and 2.65 (95% CI: 1.62-4.35), respectively. Patients who underwent PCNL in prone position were more likely to develop fever (OR: 1.23; 95% CI: 0.75-2.00) than patients in supine position. Conclusion: The current study showed that patients who suffer from diabetes mellitus, hydronephrosis, staghorn stones, nephrostomy tube or double-J stent, blood transfusion, and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.
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Received: 02 March 2022
Available online: 20 April 2024
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Corresponding Authors:
* E-mail address: alireza_jafari@gums.ac.ir (A. Jafari).
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The flow diagram of Preferred Reporting Items for Systematic reviews and Meta-Analyses. WOS, Web of Science.
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| Variable | Mean (95% confidence interval) | I2 (%) | | Age, year | 48.408 (48.406-48.411) | 99.99 | | Stone burden, mm3 | 24.390 (24.370-24.400) | 100.00 | | Stone size, mm | 27.883 (27.882-27.884) | 100.00 | | Duration of the operation, min | 72.412 (72.410-72.413) | 100.00 | | Hospitalization, day | 4.572 (4.571-4.574) | 99.99 |
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The variables in patients with postoperative fever.
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| Variable | Percentage (%)a | I2 (%) | | Gender | | Male | 57.6 (57.3-58.0) | 92.49 | | Female | 40.9 (40.5-41.2) | 90.54 | | Type of stone | | Multiple | 43.5 (42.9-44.1) | 98.12 | | Single | 34.7 (34.0-35.3) | 97.27 | | Staghorn | 28.4 (28.0-28.9) | 97.69 | | Type of PCNL procedure | | Super-mini-PCNL | 12.0 (9.6-14.8) | 78.77 | | Mini-PCNL | 8.2 (7.9-8.6) | 91.79 | | Ultra-PCNL | 10.3 (9.7-10.9) | 94.03 | | Micro-PCNL | 5.2 (2.7-9.7) | 94.23 | | Standard-PCNL | 9.3 (8.9-9.6) | 93.71 | | Total fever | 9.5 (9.3-9.7) | 92.60 | | Patient position during PCNL | | Prone | 89.9 (88.7-91.0) | 90.93 | | Supine | 50.2 (46.2-54.1) | 95.19 | | Sepsis | 4.5 (4.2-4.8) | 94.42 | | Septic shock | 2.3 (1.7-2.9) | 98.23 | | Nephrostomy tube | 9.96 (9.94-9.97) | 100.00 | | Residual stone | 20.4 (20.0-20.8) | 95.82 | | Positive urine culture | 18.3 (17.8-18.8) | 95.56 | | Urinary tract infection | 27.6 (26.7-28.5) | 97.95 | | Systemic inflammatory response syndrome | 17.6 (16.5-18.8) | 97.52 | | Country | | China | 9.7 (9.4-10.0) | 91.98 | | Egypt | 9.0 (7.3-11.0) | 60.23 | | India | 12.1 (10.9-13.4) | 84.44 | | Iran | 13.8 (11.3-16.6) | 71.58 | | Turkey | 9.6 (8.9-10.0) | 93.46 | | UK | 1.8 (1.5-2.2) | 60.98 | | USA | 17.0 (13.8-20.9) | 92.95 | | Republic of Korea | 12.1 (10.4-14.0) | 98.22 | | China (Taiwan) | 12.3 (11.0-13.6) | 65.59 | | Preoperative white blood cell, n (per microliter) | | <10 000 cells | 8.24 (8.02-8.44) | 97.84 | | ≥10 000 cells | 1.72 (1.53-1.94) | 97.68 | | Preoperative white blood cell (×109/L) | 6.401 (6.400-6.402) | 99.98 | | Pyuria | 4.55 (4.43-4.67) | 97.65 |
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The variables of patients with post-PCNL fever.
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| Variable | Number of studies | 95% CI | p-Value | I2 (%) | Odds ratio | Supplementary tables | | Gender (male/female) | 7 | 0.48-0.81 | 0.000 | 2.080 | 0.62 | S Table 1 | | Diabetes mellitus (yes/no) | 5 | 2.95-7.26 | 0.000 | 48.650 | 4.62 | S Table 2 | | Hydronephrosis (yes/no) | 6 | 0.81-1.34 | 0.717 | 0.000 | 1.04 | S Table 3 | | Staghorn stones (yes/no) | 3 | 0.93-7.11 | 0.061 | 66.350 | 2.57 | S Table 4 | | Blood transfusion (yes/no) | 3 | 1.62-4.35 | 0.000 | 0.000 | 2.65 | S Table 5 | | Nephrostomy tube or double-J stent (yes/no) | 3 | 0.40-1.93 | 0.185 | 40.700 | 0.88 | S Table 6 | | Position (supine/prone) | 6 | 0.75-2.00 | 0.398 | 38.604 | 1.23 | S Table 7 |
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The odds ratio analyses of fever in patients with diabetes mellitus, hydronephrosis, blood transfusion, nephrostomy tube or double-J stent, staghorn stones, and different types of position (supine or prone) after percutaneous nephrolithotomy.
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