SOFA (Sequential Organ Failure Assessment score) score is a valuable tool to evaluate for preoperative percutaneous nephrostomy (PCN) insertion before ureteroscopic lithotripsy (URSL) to prevent postoperative sepsis.
As technology has advanced, ureteroscopy(URS) can now be used for most ureteral stone removals. However, infection is still the most common complication. Preoperative PCN insertion for kidney drainage before URSL is a good practice to decrease postoperative sepsis rate. Sequential Organ Failure Assessment (SOFA) scores have been advocated to evaluate sepsis recently. The aim of this study is to use SOFA scores to retrospectively evaluate whether preoperative PCN insertion before URSL prevents postoperative sepsis.
We conducted a retrospective review of all URSL procedures performed at China Medical University Hospital from September 1st 2014 to December 31st 2016. The definition of sepsis is based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) published February 23rd 2016 by JAMA. We collected and analyzed the data between postoperative sepsis and non-sepsis patients which included clinical characteristics, preoperative SOFA score, surgical outcomes, multivariate analysis of affecting factors for postoperative sepsis, and ROC curve of preoperative PCN insertion and postoperative sepsis for patients with high SOFA scores.
A total of 830 patients underwent URSL during the 28 month period. Thirty-two (3.9%) patients suffered from postoperative sepsis. Multivariate analysis of affecting factors for postoperative sepsis showed significant difference in age, proximal ureteral stone, severe hydronephrosis, and high preoperative SOFA score. Fifty-eight (7.0%) patients scored above 3 points for SOFA preoperatively. Among these patients, 26 patients (45.8%) got postoperative sepsis, and 32 patients (55.2%) were free of postoperative sepsis. Among these 32 patients, 22 (68.8%) patients had preoperative PCN insertion and were free of postoperative sepsis. Conversely, among these 26 patients, 22 (84.6%) patients did not have preoperative PCN insertion and contracted sepsis postoperatively. The P-value was 0.008, and the odds ratio was 12.1. The area under curve (AUC) was 0.767.
This study showed the ability of preoperative SOFA scores to predict the post-URSL sepsis rate. By using this convenient and effective tool, patients who are most likely to suffer from post-URSL sepsis can be efficiently identified. Further preventive strategy includes percutaneous nephrostomy (PCN) which can be performed pre-URSL to achieve the better URSL surgical outcomes.