Risk factors for blood transfusion following percutaneous nephrolithotomy in the UK
BAUS ePoster online library. Withington J.
Jun 26, 2018; 211313
Mr. John Withington
Mr. John Withington
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Introduction: Percutaneous nephrolithotomy (PCNL) is routinely utilized in the management of large renal stones and staghorn calculi. PCNL is more efficacious when compared to other treatment modalities but carries an increased risk of morbidity. Vascular injury and hemorrhage are known complications of PCNL with associated risk of blood transfusion. We sought to describe procedural and patient risk factors for blood transfusion using a national prospective data registry.

Patients and Methods: Data submitted to the BAUS PCNL data registry between 2011 and 2017 were analyzed for rates of blood transfusion. We assessed risk factors for transfusion, including operator performing renal puncture (urologist versus radiologist), patient position (prone versus supine), size of renal access (6-24 French versus 25-30 French), stone size (< 2 cm versus >2 cm), stone complexity defined by Guy's stone score (I-II versus III-IV), patient comorbidities (spina bifida, kyphoscoliosis, and spinal cord injury), BMI, and preoperative hemoglobin.

Results: Of 9,139 PCNL's, 198 patients required blood transfusion (2.2%). Significantly greater transfusion rates were observed for more complex stones, larger stones, larger renal access size, and preop Hb <120 (Table 1). Underweight patients and patients with normal BMI had higher transfusion rates when compared to overweight and obese patients. No difference was observed with patient position, patient comorbidity, or operator performing renal puncture.

Conclusions: Risk of transfusion after PCNL increases with larger more complex stones and when larger renal access size is used. Patients with low preoperative Hb and with lower BMI may be at increased risk for transfusion.
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