Ten-Year Sepsis Rates Comparing Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Laser Lithotripsy in an Australian Population
Abstract
Objectives To compare the rate and predictors of septic complications after shock wave lithotripsy (SWL) and
flexible ureteroscopy and laser lithotripsy (FURS) in an Australian population.
Methods Hospital admission data were extracted from the Victorian Admitted Episodes Dataset (VAED) regarding
all elective admissions for SWL and FURS for treatment of intrarenal stones from 2009 to 2018, inclusive. Sepsis was
defined by the ICD-10 diagnostic code, A41.
Results There were 13 154 inpatient episodes analysed, comprising SWL (6033) and ureterorenoscopic laser
lithotripsy (7121). Males made up 67.43% of SWL patients and 63.34% of FURS patients. Median age was 57 years in
both groups. Median American Society of Anesthesiologists physical status classification grade (ASA grade) was 2 for
both groups, but proportionally more FURS patients were ASA grade 3 to 4 (P < 0.001). Postoperative sepsis was more
common in the FURS group (1.43% vs. 0.03%), as was intensive care unit admission (1.00% vs. 0.10%). Average length
of stay was longer for FURS (1.43 days vs. 1.06 days). There were 4 inpatient deaths, all from the FURS group. FURS
procedure, female sex, and a higher ASA grade were each independent predictors of sepsis.
Conclusions FURS may have a significantly higher relative risk of postoperative sepsis than SWL in high-risk
patients as determined in this study. While overall risk is low, higher comorbidity (ASA grade 3 or 4) and female sex
were independent predictors of sepsis. For these patients in particular, and when clinically appropriate, SWL may be
considered as a potentially safer alternative to FURS.
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