Premium
Emergency nephrectomy due to severe urosepsis: a retrospective, multicentre analysis of 65 cases
Author(s) -
Berger Ingrid,
Wildhofen Sonja,
Lee Alexander,
Ponholzer Anton,
Rauchenwald Michael,
Zechner Othmar,
Stackl Walter,
Madersbacher Stephan
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08414.x
Subject(s) - medicine , nephrectomy , percutaneous nephrostomy , surgery , retrospective cohort study , comorbidity , stent , percutaneous , kidney
OBJECTIVE To assess the outcome of emergency nephrectomy in a retrospective, multicentre analysis, as emergency nephrectomy due to life‐threatening urosepsis is a rare clinical scenario with a high mortality, and there are few reports of clinical data on this issue. PATIENTS AND METHODS We assessed retrospectively all patients who had a nephrectomy due to life‐threatening urosepsis in three referral centres in Vienna between 1994 and 2007. Patient characteristics, survival and risk factors for a fatal outcome were evaluated. RESULTS In all 65 patients (44 women and 21 men; mean age 65 years) were analysed. The mean interval from the first medical consultation to hospital admission was 4.3 days. Two‐thirds of patients were admitted directly from their homes (63%), the remainder being transferred from other departments or hospitals. The most common pathological mechanism leading to urosepsis was acute pyelonephritis, often combined with nephrolithiasis. In all, 36 patients had a urological intervention before nephrectomy, i.e. percutaneous nephrostomy in 17, ureteric stent in 16 and percutaneous abscess drainage in three. Nephrectomy was performed a mean (range) of 5.7 (0–31) days after hospital admission. Thirteen patients (20%) died from septic multi‐organ failure after surgery. This group was almost 20 years older than those who survived (78.6 vs 61.8 years), had a higher comorbidity rate, had undergone endourological interventions more frequently (69% vs 52%), had a longer interval to nephrectomy (6.9 vs 5.4 days), higher C‐reactive protein level (294.9 vs 136.0 mg/L) and lower platelet counts (229.5 vs 307.7 million/L) at diagnosis. CONCLUSION Several factors were identified that influence the outcome after emergency nephrectomy for life‐threatening urosepsis. Applied to the decision‐making process, these risk factors could have a positive impact on establishing a timely indication for nephrectomy that might ultimately reduce the high mortality rate.