Mini-Endoscopic Combined Intrarenal Surgery in Patients with Poor Performance Status: A Retrospective Analysis of Postoperative Fever in Over 1000 Cases

Objective: To assess the safety of mini-endoscopic combined intrarenal surgery (mini-ECIRS) in patients with a poor performance status (PS). Methods: A retrospective analysis was conducted on 1132 patients who underwent mini-ECIRS at 3 hospitals between January 2015 and December 2021. Patients were classified according to their PS (PS0-1 and PS2-4 groups) and compared between the groups in terms of preoperative drainage status, such as ureteral stent or percutaneous nephrostomy (PNS), stone characteristics, surgical outcomes, and postoperative fever. Multivariate logistic regression models were used to identify the predictive factors for postoperative fever in each PS group. Results: Patients in the PS2-4 group were older and had a higher stone burden than those in the PS0-1 group. The stone-free rates and surgical success rate were similar between the PS groups, but PS2-4 patients had higher rates of postoperative fever without preoperative drainage. Stone composition analysis revealed a higher prevalence of infectious stones in the PS2-4 group. In the PS0-1 group, PNS reduced postoperative fever risk (odds ratio (OR): 0.65, 95% CI: 0.48-0.89, P = .01), and history of febrile urinary tract infection, stone burden ! 30 mm, number of involved calyces ! 4, and female sex were independent risk factors. Notably, in the PS2-4 group, PNS remained effective against postoperative fever (OR: 0.24, 95% CI: 0.07-0.80, P = .02), while no other factors were significant. Conclusion: The mini-ECIRS was effective even in PS-poor patients, and they may benefit more from preoperative PNS placement than normal PS cases.