Application of multidisciplinary management to prevent postoperative urogenic sepsis after day surgery of PCNL

doi:10.3877/cma.j.issn.1674-3253.2025.05.011

Abstract

Abstract:

Objective

To explore the effectiveness of combining clinical data analysis, optimizing multidisciplinary treatment (MDT), and following the PDCA principle to reduce the incidence of postoperative urogenic sepsis after day surgery of percutaneous nephrolithotomy (PCNL).

Methods

A retrospective analysis was conducted on the clinical data of 245 patients with kidney stones who underwent day surgery of PCNL in our hospital from April 2019 to April 2021. The patients were divided into a urogenic sepsis group and non-urogenic sepsis group. Multivariate Logistic regression analysis was used to identify independent risk factors for urogenic sepsis, and the multidisciplinary treatment (MDT) was optimized. The PDCA cycle theory was used to improve the clinical process. Retrospective analysis of 77 patients with kidney stones treated with PCNL in our hospital from May 2021 to May 2022 following implementation of PDCA, compared with the incidence of sepsis before PDCA implementation.

Results

Combined with diabetes, complex stones (stone diameter >2.5 cm) and positive urine culture were independent risk factors for urogenic sepsis (P<0.05). The incidence of urogenic sepsis from April 2019 to April 2021 was 7.35%, through the implementation of MDT and PDCA principles, while from May 2021 to May 2022, the incidence decreased to 1.29%. Compared with before optimization, the incidence of urogenic sepsis significantly decreased (P=0.033).

Conclusion

Optimizing MDT and utilizing PDCA cycle intervention can effectively prevent the occurrence of urogenic sepsis, improve surgical safety and treatment effectiveness.

Key words: Multidisciplinary treatment, PCNL, Urogenic sepsis, Kidney stone, Negative pressure suction sheath, Day surgery

Ran Tao, Cong Yin, Shaobo Ye, Xinping Yang, Jie Tian, Lihong Xiong, Jinbin Wu, Hongbing Mei. Application of multidisciplinary management to prevent postoperative urogenic sepsis after day surgery of PCNL[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(05): 615-621.

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References 34

[1]	Lorenzo Soriano L, Ordaz Jurado DG, Pérez Ardavín J, et al. Predictive factors of infectious complications in the postoperative period of percutaneous nephrolithotomy[J]. Actas Urológicas Españolas Engl Ed, 2019, 43(3): 131-136. DOI: 10.1016/j.acuroe.2019.02.002.
[2]	Reinhart K, Bauer M, Riedemann NC, et al. New approaches to sepsis: molecular diagnostics and biomarkers[J]. Clin Microbiol Rev, 2012, 25(4): 609-634. DOI: 10.1128/CMR.00016-12.
[3]	Pandey S, Sankhwar SN, Goel A, et al. Quick sequential (sepsis related) organ failure assessment: a high performance rapid prognostication tool in patients having acute pyelonephritis with upper urinary tract calculi[J]. Investig Clin Urol, 2019, 60(2): 120-126. DOI: 10.4111/icu.2019.60.2.120.
[4]	Wagenlehner FME, Tandogdu Z, Bjerklund Johansen TE. An update on classification and management of urosepsis[J]. Curr Opin Urol, 2017, 27(2): 133-137. DOI: 10.1097/MOU.0000000000000364.
[5]	陈蕾, 戴菲菲, 张绍峰, 等. 行政MDT结合PDCA方法在围手术期管理中的应用[J]. 江苏卫生事业管理, 2021, 32(11): 1470-1471, 1485. DOI:10.3969/j.issn.1005-7803.2021.11.017.
[6]	Evans L,Rhodes A,Alhazzani W, et al. Surviving sepsis campaign:international Guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47(11):1181-1247. DOI: 10.1007/s00134-021-06506-y.
[7]	唐明坤, 孙海霞, 吴思竹, 等. 基于机器学习的脓毒症早期预测研究进展[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(5): 428-433.
[8]	Nicoll JH. The surgery of infancy[J]. BMJ, 1909, 2(2542): 753-754.
[9]	Jones P, Bennett G, Dosis A, et al. Safety and efficacy of day-case percutaneous nephrolithotomy: a systematic review from European society of uro-technology[J]. Eur Urol Focus, 2019, 5(6): 1127-1134. DOI: 10.1016/j.euf.2018.04.002.
[10]	Xiong W, Li M, Wang M, et al. The safety of laparoscopic cholecystectomy in the day surgery unit comparing with that in the inpatient unit: a systematic review and meta-analysis[J]. Biomed Res Int, 2020, 2020: 1924134. DOI: 10.1155/2020/1924134.
[11]	Assimos DG. Re: EAU guidelines on interventional treatment for urolithiasis[J]. J Urol, 2016, 195(3): 659. DOI: 10.1016/j.juro.2015.12.022.
[12]	陈奇, 董樑, 李佳怡, 等. 上海仁济医院泌尿外科日间手术实践探索[J]. 中华医院管理杂志, 2017, 33(5): 349-351. DOI: 10.3760/cma.j.issn.1000-6672.2017.05.008.
[13]	严文江, 贾本忠. 经皮肾镜碎石术后并发尿源性毒血症相关危险因素分析[J].医药前沿，2018, 8(36): 123. DOI: 10.3969/j.issn.2095-1752.2018.36.102.
[14]	Scotland KB, Lo J, Grgic T, et al. Ureteral stent-associated infection and sepsis: pathogenesis and prevention: a review[J]. Biofouling, 2019, 35(1): 117-127. DOI: 10.1080/08927014.2018.1562549.
[15]	苏志勇, 张珩, 田野, 等. 日间微通道经皮肾镜碎石取石术30例[J]. 中国微创外科杂志, 2021, 21(4): 336-339. DOI: 10.3969/j.issn.1009-6604.2021.04.011.
[16]	苟扬, 姜庆. 肾结石行经皮肾镜取石术的临床应用及术后尿源性脓毒血症发生的危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2022, 16(2): 183-186. DOI: 10.3877/cma.j.issn.1674-0785.2022.02.014.
[17]	Zeng G, Zhong W, Mazzon G, et al. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy [J].Minerva Urol Nephrol, 2022, 74(6): 653-668. DOI: 10.23736/S2724-6051.22.04752-8.
[18]	Zeng G, Zhong W, Pearle M, et al. European association of urology section of urolithiasis and international alliance of urolithiasis joint consensus on percutaneous nephrolithotomy[J]. Eur Urol Focus, 2022, 8(2): 588-597. DOI: 10.1016/j.euf.2021.03.008.
[19]	Patel RM, Jefferson FA, Owyong M, et al. Characterization of intracalyceal pressure during ureteroscopy[J]. World J Urol, 2021, 39(3): 883-889. DOI: 10.1007/s00345-020-03259-z.
[20]	Margel D, Ehrlich Y, Brown N, et al. Clinical implication of routine stone culture in percutaneous nephrolithotomy-a prospective study[J]. Urology, 2006, 67(1): 26-29. DOI: 10.1016/j.urology.2005.08.008.
[21]	Zhong W, Zeng G, Wu K, et al. Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever?[J]. J Endourol, 2008, 22(9): 2147-2151. DOI: 10.1089/end.2008.0001.
[22]	Zeng G, Wan S, Zhao Z, et al. Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation[J]. BJU Int, 2016, 117(4): 655-661. DOI: 10.1111/bju.13242.
[23]	厉晓伟, 袁杰, 沈大渝, 等. 输尿管软镜联合负压吸引鞘治疗复杂肾结石的疗效和安全性[J]. 江苏大学学报(医学版), 2024, 34(4): 317-320. DOI: 10.13312/j.issn.1671-7783.y240021.
[24]	常海, 王林峰, 张高杰, 等. 局麻下可弯曲负压鞘联合输尿管软镜治疗≥3 cm肾结石的有效性和安全性研究[J]. 重庆医科大学学报, 2024, 49(6): 669-673. DOI: 10.13406/j.cnki.cyxb.003524.
[25]	Liu Y, Zhu W, Zeng G. Percutaneous nephrolithotomy with suction: is this the future? [J]. Curr Opin Urol, 2021, 31(2): 95-101. DOI: 10.1097/MOU.0000000000000854.
[26]	吕联辉, 张文彬, 洪泓长.Y型扩张引流鞘在部分无管化微通道经皮肾镜碎石取石术中的应用[J]. 微创泌尿外科杂志, 2022, 11(3): 166-170. DOI: 10.19558/j.cnki.10-1020/r.2022.03.005.
[27]	Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 762-774. DOI: 10.1001/jama.2016.0288.
[28]	李新元. 泌尿外科医院感染病原菌及耐药性分析[J]. 中国病原生物学杂志, 2013, 8(4): 365-367. DOI: 10.13350/j.cjpb.2013.04.024.
[29]	中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 临床急诊杂志, 2018, 19(9): 567-588. DOI: 10.13201/j.issn.1009-5918.2018.09.001.
[30]	张建伟, 朱朝霞, 宋明辉, 等. 临床药师对钬激光碎石术后尿源性脓毒血症患者的药学监护[J]. 中国医院用药评价与分析, 2018, 18(6): 862-864. DOI: 10.14009/j.issn.1672-2124.2018.06.048.
[31]	王科, 张智宇, 吴吉涛, 等. 加速康复外科多学科模式在泌尿外科临床的实践探索[J]. 现代泌尿外科杂志, 2018, 23(3): 161-164, 168. DOI: 10.3969/j.issn.1009-8291.2018.03.001.
[32]	马小菊, 黎婉斌, 何达秋, 等. 基于多学科协作的HFMEA对医院感染的控制效果[J]. 暨南大学学报(自然科学与医学版), 2024, 45(4): 420-427. DOI: 10.11778/j.jdxb.20240005.
[33]	陈劭泱，娄雪萍，郑贞苍，等.PDCA循环在预防经皮肾镜取石术不良事件中的应用[J]. 浙江临床医学, 2018, 20(3): 548-549.
[34]	Chowdhury S, Mok D, Leenen L. Development of the Saudi Arabian trauma system[J]. J Med Life, 2022, 15(1): 34-42. DOI: 10.25122/jml-2021-0066.

项目	尿源性脓毒症(n=18)	非尿源性脓毒症(n=227)	χ²值	P值
性别			8.117	0.004
男	3 (16.7)	117 (51.5)
女	15 (83.3)	110 (48.5)
年龄			11.148	<0.001
≥60岁	16 (88.9)	109 (48.0)
< 60岁	2 (11.1)	118 (52.0)
高血压			1.406	0.236
有	4 (22.2)	23 (10.1)
无	14 (77.8)	204 (89.9)
糖尿病			50.190	<0.001
有	13 (72.2)	21 (9.3)
无	5 (27.8)	206 (90.7)
结石直径			20.617	<0.001
> 2.5 cm	13 (72.2)	48 (21.1)
≤2.5 cm	5 (27.8)	179 (78.9)
结石部位			0.504	0.478
肾结石	14 (77.8)	197 (86.8)
输尿管结石	4 (22.2)	30 (13.2)
尿白细胞			5.501	0.019
> 100/μL	13 (72.2)	99 (43.6)
≤100/μL	5 (27.8)	128 (56.4)
尿培养			9.175	0.002
阳性	15 (83.3)	105 (46.3)
阴性	3 (16.7)	122 (53.7)
术前抗菌药物使用			1.367	0.242
无	13 (72.2)	132 (58.1)
有	5 (27.8)	95 (41.9)
冲洗量			5.599	0.018
> 20 L	15 (83.3)	124( 54.6)
≤20 L	3 (16.7)	103 (45.4)
手术时间			1.711	0.191
> 60 min	12 (66.7)	115 (50.7)
≤60 min	6 (33.3)	112 (49.3)

项目	尿源性脓毒症(n=18)	非尿源性脓毒症(n=227)	χ²值	P值
性别			8.117	0.004
男	3 (16.7)	117 (51.5)
女	15 (83.3)	110 (48.5)
年龄			11.148	<0.001
≥60岁	16 (88.9)	109 (48.0)
< 60岁	2 (11.1)	118 (52.0)
高血压			1.406	0.236
有	4 (22.2)	23 (10.1)
无	14 (77.8)	204 (89.9)
糖尿病			50.190	<0.001
有	13 (72.2)	21 (9.3)
无	5 (27.8)	206 (90.7)
结石直径			20.617	<0.001
> 2.5 cm	13 (72.2)	48 (21.1)
≤2.5 cm	5 (27.8)	179 (78.9)
结石部位			0.504	0.478
肾结石	14 (77.8)	197 (86.8)
输尿管结石	4 (22.2)	30 (13.2)
尿白细胞			5.501	0.019
> 100/μL	13 (72.2)	99 (43.6)
≤100/μL	5 (27.8)	128 (56.4)
尿培养			9.175	0.002
阳性	15 (83.3)	105 (46.3)
阴性	3 (16.7)	122 (53.7)
术前抗菌药物使用			1.367	0.242
无	13 (72.2)	132 (58.1)
有	5 (27.8)	95 (41.9)
冲洗量			5.599	0.018
> 20 L	15 (83.3)	124( 54.6)
≤20 L	3 (16.7)	103 (45.4)
手术时间			1.711	0.191
> 60 min	12 (66.7)	115 (50.7)
≤60 min	6 (33.3)	112 (49.3)

因素	回归系数	SE	P值	OR值	95%CI
性别（男性=0，女性=1）	2.324	1.186	0.050	0.098	0.010~1.000
年龄（<60=0，≥60=1）	0.976	0.947	0.303	2.655	0.415~17.003
高血压（无=0，有=1）	1.386	0.990	0.161	3.998	0.575~27.813
糖尿病（无=0，有=1）	4.012	1.003	<0.001	55.257	7.741~394.451
结石直径(≤2.5 cm=0，>2.5 cm=1)	2.617	1.017	0.010	13.696	1.866~100.519
结石部位（肾结石=0，输尿管结石=1）	1.639	1.131	0.147	0.194	0.021~1.783
尿白细胞（<100/μL=0，>100/μL=1）	1.030	0.892	0.248	2.801	0.488~16.091
尿培养（阴性=0，阳性=1）	2.350	1.059	0.026	10.484	1.316~83.493
术前抗菌药物使用（无=0，有=1）	-1.022	0.834	0.220	0.360	0.070~1.843
冲洗量（≤20 L=0，>20 L=1）	1.159	0.920	0.208	3.188	0.525~19.352
手术时间（≤60 min=0，>60 min=1）	0.158	0.966	0.870	1.171	0.176~7.779
常量	-7.039	1.780	<0.001	0.001

因素	回归系数	SE	P值	OR值	95%CI
性别（男性=0，女性=1）	2.324	1.186	0.050	0.098	0.010~1.000
年龄（<60=0，≥60=1）	0.976	0.947	0.303	2.655	0.415~17.003
高血压（无=0，有=1）	1.386	0.990	0.161	3.998	0.575~27.813
糖尿病（无=0，有=1）	4.012	1.003	<0.001	55.257	7.741~394.451
结石直径(≤2.5 cm=0，>2.5 cm=1)	2.617	1.017	0.010	13.696	1.866~100.519
结石部位（肾结石=0，输尿管结石=1）	1.639	1.131	0.147	0.194	0.021~1.783
尿白细胞（<100/μL=0，>100/μL=1）	1.030	0.892	0.248	2.801	0.488~16.091
尿培养（阴性=0，阳性=1）	2.350	1.059	0.026	10.484	1.316~83.493
术前抗菌药物使用（无=0，有=1）	-1.022	0.834	0.220	0.360	0.070~1.843
冲洗量（≤20 L=0，>20 L=1）	1.159	0.920	0.208	3.188	0.525~19.352
手术时间（≤60 min=0，>60 min=1）	0.158	0.966	0.870	1.171	0.176~7.779
常量	-7.039	1.780	<0.001	0.001

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