Risk Factors for Severe Hemorrhage Requiring Blood Transfusion Associated With Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

 

Abstract

Purpose: The aim of this meta-analysis was to systematically assess the risk factors for severe hemorrhage requiring blood transfusion associated with percutaneous nephrolithotomy, so that the urologist can prevent the occurrence of severe bleeding as soon as possible.

Materials and Methods: PubMed, Embase and The Cochrane Library were searched to collect the case-control studies on risk factors for severe hemorrhage requiring blood transfusion associated with percutaneous nephrolithotomy (PCNL) through Nov. 9, 2020. Eligible data was screened, extracted, and the risk of bias assessed independently by two qualified investigators. We then calculated the odds risks (ORs) and corresponding 95% confidence intervals (CIs) to assess the relationships between risk factors and severe hemorrhage requiring blood transfusion associated with PCNL.

Results: Eight case-control studies involving 5,974 patients were screened. In this meta-analysis, the risk factors were extracted as follow: gender, hypertension, diabetes mellitus, multiple tracts, staghorn calculi, previous PCNL, grade of hydronephrosis (moderate and severe), calyx of puncture (lower, middle, upper, multiple calices). Among them, diabetes mellitus (95% CI: 1.13 – 3.22, OR = 1.90, P = .016), multiple tracts (95% CI: 2.28 – 7.02, OR = 4.00, P = .000), staghorn calculi (95% CI: 1.34 - 4.08, OR = 2.34, P = .003), upper calyx (calyx of puncture) (95% CI: 0.40 - 0.86, OR = 0.59, P = .006), multiple calices (calyx of puncture) (95% CI: 1.79 - 3.20, OR = 2.39, P = .006) were statistically significant (all P < 0.05).

Conclusions: Our meta-analysis showed that diabetes mellitus, multiple tracts, staghorn calculi, multiple calices (calyx of puncture) are risk factors for severe hemorrhage requiring blood transfusion associated with PCNL, so we should focus on their prevention. Moreover, upper calyx (calyx of puncture) is a protective factor, the urologist may choose upper pole access as percutaneous nephrolithotomy tract to minimize intraoperative and postoperative blood loss

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