The Association of Perioperative Glycated Hemoglobin (Hemoglobin A1C) and the Risk of Sepsis after Ureteroscopy with Laser Lithotripsy

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Abstract
Purpose: Elevated glycated hemoglobin A1c (HbA1c) has not been specifically evaluated as a risk factor for urosepsis after kidney stone procedures. Moreover, there are no current guidelines for perioperative HbA1c optimization, nor recommendations for the optimal timing to treat non-urgent kidney stones in the setting of poor glycemic control. We evaluated the association between perioperative HbA1c levels and sepsis risk after ureteroscopy with lithotripsy. Methods: Patients undergoing ureteroscopy with lithotripsy from January 2020 to June 2023 at a tertiary center were retrospectively reviewed. Postoperative sepsis was defined as Systemic Inflammatory Response Syndrome scores ≥2 within 30 days after ureteroscopy. The risk of sepsis at various HbA1c thresholds was evaluated via multivariate logistic regression. Results: A total of 1454 patients underwent ureteroscopy with lithotripsy, and 319 patients had HbA1c collected within 90 days of their procedures. The mean preoperative Charlson Comorbidity Index (CCI) score was 3.22 (±2.77). An increased risk of sepsis was observed among patients with HbA1c levels between 8.0% and 9.9% (odds ratio [OR] 4.42, p = 0.025) and ≥10% (OR 8.17, p = 0.003). Positive preoperative urine culture despite treatment (OR 4.53, p < 0.001) and higher CCI (OR 1.17, p = 0.045) were also associated with increased odds of sepsis. Conclusion: The odds of sepsis after ureteroscopy with lithotripsy follow a dose–response relationship with elevated perioperative HbA1c. These data underscore the clinical utility of incorporating HbA1c into preprocedural optimization and may justify certain patients to delay elective ureteroscopy to improve glycemic control before endourologic intervention.

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