Abstract
BACKGROUND: Percutaneous nephrolithotomy (PNL) is the standard treatment for medium-sized and large kidney stones. Many potential complications of PNL may warrant hospital readmission (HR) after discharge, threatening patient safety and increasing the costs. AIM: To estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors. METHODS: One hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022. The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR, using univariate and multivariate analyses. Variables such as the demographic characteristics, comorbidities, laboratory and imaging characteristics, dietary status, operative time, number of kidney punctures, blood loss, urinary tract infections, and the receipt of instructions for catheter care and activities of daily living were included. A risk score was created. RESULTS: The mean age of patients with HR (44.4 ± 12.7 years) and without HR (43.9 ± 12.6 years) was similar (P = 0.847). The overall stone-free rate was 88.8%. The total complication rate was 32.3% (52 patients), and the highest grade was IIIa, according to the modified Clavein grading system, resulting in an HR rate of 22.4%. History of preoperative pyuria (P = 0.001), hydronephrosis (P = 0.001) and mean stone size (P = 0.012), multiple renal punctures (P < 0.001), double J stent (P = 0.033), total operative time (P = 0.001), intraoperative injury (P = 0.011), postoperative urinary tract infection (P < 0.001), and inadequate instructions for urethral catheter (P = 0.001) and activity daily living (P = 0.048) were significantly associated with HR after PNL. On multivariate analysis, only preoperative pyuria (P = 0.004), intraoperative injury (P = 0.001), and inadequate instructions on urethral catheter care (P = 0.035) were associated with HR. The risk score of the independent predictors was 0-17; 0-4 (low risk), 5-9 (moderate risk), and 10-17 (high risk). CONCLUSION: The rate of unplanned HR after PNL was relatively high (22.4%). The presence of pus cells in the preoperative urine analysis, intraoperative injury, and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL. Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.