Pd10-03 the Association Between Perioperative Hemoglobin A1c and Sepsis After Endourologic Surgery

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) II (PD10)1 May 2024PD10-03 THE ASSOCIATION BETWEEN PERIOPERATIVE HEMOGLOBIN A1C AND SEPSIS AFTER ENDOUROLOGIC SURGERY Richard B. Berman, Justin Lee, Adithya Balasubramanian, Hriday Bhambhvani, and Ojas Shah Richard B. BermanRichard B. Berman , Justin LeeJustin Lee , Adithya BalasubramanianAdithya Balasubramanian , Hriday BhambhvaniHriday Bhambhvani , and Ojas ShahOjas Shah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008748.59024.cb.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The link between elevated hemoglobin A1c (HbA1c) and postsurgical infections is well known. However, perioperative HbA1c has not been evaluated specifically as a risk factor for urosepsis following kidney stone surgery. There are no current guidelines for ideal perioperative HbA1c values, nor are there recommendations for the optimal timing to treat non-urgent obstructing stones. We evaluated the effect of perioperative A1c levels on the risk of sepsis following endourologic surgery. METHODS: Patients undergoing ureteroscopy, shockwave lithotripsy, or percutaneous nephrolithotomy from January 2020 to June 2023 at a tertiary care medical center were retrospectively reviewed. Postoperative sepsis was defined as Systemic Inflammatory Response Syndrome (SIRS) scores ≥2 following surgery. The risk of sepsis at various HbA1c thresholds was evaluated via multivariate logistic regression, adjusted for demographic and clinical characteristics. RESULTS: 1,946 patients underwent stone procedures, and 384 patients had HbA1c laboratory values within 90 days of surgery. The mean preoperative Charlson Comorbidity Index (CCI) score was 3.19 (± 2.75). 31% of patients had A1c ≥6.5%. As compared to patients with HbA1c <5.7%, there was an increased risk of sepsis in patients with elevated HbA1c: 6.5% - 7.99% (odds ratio OR 3.30, p=0.025), 8.0% - 9.99% (OR 6.19, p=0.003), and≥10% (OR 10.47, p=0.001). Positive preoperative urine culture (OR: 5.05, p<0.001), stone size (OR per mm: 1.04, p=0.050), and higher CCI scores (OR: 1.16, p=0.046) were also associated with increased odds of sepsis. Stent or nephrostomy tube placement, stone location, and surgery length were not associated with postoperative sepsis. CONCLUSIONS: We identified a dose-response relationship between perioperative HbA1c and sepsis following endourologic surgery. These data underscore the utility of incorporating HbA1c into presurgical optimization and suggest patients with elevated A1c may benefit from delaying elective endourologic procedures until HbA1c is improved. Download PPT Source of Funding: The research was supported by a T35 training award from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant Number: 5T35DK093430 June 2023 - August 2023 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e186 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Richard B. Berman More articles by this author Justin Lee More articles by this author Adithya Balasubramanian More articles by this author Hriday Bhambhvani More articles by this author Ojas Shah More articles by this author Expand All Advertisement PDF downloadLoading ...