Moderated Poster

Poster, Podium & Video Sessions

MP96-20: Challenging the Paradigm of Mandatory Overnight Observation after Elective Percutaneous Nephrostomy Tube Placement

Tuesday, May 16
9:30 AM - 11:30 AM
Location: BCEC: Room 153

Presentation Authors: Jennifer Robles*, Nicole Miller, Nashville, TN

Introduction: The typical paradigm for patients who undergo elective percutaneous nephrostomy tube placement (PCN) is 23-hr observation to monitor for post-procedure complications such as sepsis or bleeding. However, many similar Interventional Radiology (IR) procedures such as biopsies or abscess drainage are done on an outpatient basis. This maximizes patient and provider satisfaction while reducing medical costs and resource utilization. Our objective is to evaluate the safety of elective PCN placement and to identify which groups should be considered for outpatient PCN placement.

Methods: We performed a retrospective chart review of 374 patients at our institution who underwent PCN or nephroureteral tube placement by IR from 1/2014 - 1/2016. We excluded inpatients, patients with suspected urosepsis, pregnancy, age <18 yrs or pelvic kidneys. All patients were admitted for observation. We collected data on demographics, clinical characteristics, procedural details and post-PCN clinical course. T-test and Chi-squared analysis were used to assess risk factors for statistical significance.

Results: We identified 94 patients who underwent electively scheduled PCN placement (see Table 1). There were no major (Clavien Gr III-IV) complications, episodes of sepsis or hemorrhage. There were 8 patients (9%) with systemic inflammatory response syndrome (SIRS): tachycardia (6), fevers (5) and chills (2). Excluding a patient with pancytopenia due to chemotherapy, 100% of patients with SIRS had stones, 6/7 had staghorn stones (p=0.001) and 5/7 had been treated for positive cultures pre-PCN. They were also statistically more likely to have had difficult procedures & positive PCN cultures. Neither chronically colonized or purulent-appearing urine were associated with complications.

Conclusions: Our data suggests that most patients do not require admission for observation after elective PCN placement. Risk factors for post-PCN complications include large stone burden, longer fluoroscopy time, and difficult PCN access. One-third of patients with staghorn stones developed SIRS and they accounted for the majority of complications despite pre-PCN antibiotic treatment, highlighting the importance of renal pelvic urine cultures and close post-procedural observation for this high-risk group.

Source Of Funding: none

Jennifer Robles, MD

Vanderbilt University Medical Center

Jennifer Robles M.D. is currently an Endourology and Lap/Robotic Surgery Fellow at Vanderbilt University Medical Center in Nashville, TN. She completed her Urologic Surgery Residency at Washington University in St. Louis in 2016. Her primary academic interest is in urologic and surgical quality improvement and she will be a VA Quality Scholars Fellow from 2017-2019 and complete a Masters in Public Health as part of this program.

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