Evaluating postoperative complications in standard percutaneous nephrolithotomy for renal stones larger than 2 cm: a retrospective study utilizing the E-PASS scoring system.

Abstract

Percutaneous nephrolithotomy (PCNL) is a widely preferred method for treating complex kidney stones, particularly in patients with larger or more complicated stones. Despite its advantages, such as minimal invasiveness and a shorter recovery time, postoperative complications can occur, thereby necessitating effective risk assessment tools to identify at-risk patients. This study evaluated the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system's utility in predicting postoperative complications following standard PCNL. This retrospective study included 218 patients who underwent standard PCNL from June 2020 to August 2024 at our institution. Data on demographics, comorbidities, and perioperative factors were collected and analyzed. Postoperative complications were classified using the modified Clavien-Dindo system. The E-PASS scoring system, which incorporates the Preoperative Risk Score (PRS), Surgical Stress Score (SSS), and Comprehensive Risk Score (CRS), was applied to stratify risk. Postoperative complications occurred in 38 patients (17.4%). Significant predictors included advanced age, higher American Society of Anesthesiologists (ASA) scores, and comorbidities like diabetes and coronary artery disease. Intraoperative factors, such as prolonged operative times, number of access and greater blood loss, were also associated with complications. Multivariate analysis identified higher CRS and greater stone burden as independent predictors (p = 0.012 and p = 0.037, respectively). The CRS demonstrated moderate discrimination, with an area under the curve (AUC) of 0.747. The E-PASS scoring system effectively predicts postoperative complications in PCNL, underscoring the importance of thorough preoperative and intraoperative evaluation. Future studies should explore its broader applicability across other urological procedures.