Does preoperative nephrostomy increase the incidence of wound infection after nephrectomy?

Objectives. To determine whether patients with nephrostomy after simple nephrectomy more often had postoperative wound complication than did matched patients without nephrostomy. Methods. The hospital records of patients who underwent retroperitoneal simple nephrectomy were evaluated, and the following data were retrieved: age, indication for nephrectomy and nephrostomy insertion, medical history, urine culture, antibiotic regimen, time elapsed from nephrostomy insertion to nephrectomy, surgical technique, type of complication, time elapsed from surgery to complication, treatment, and outcome of complications. Results. Thirty-one patients (mean age 57.9 years, ± SE 3.0) were evaluated. Seven (31.8%) of the 22 patients without nephrostomy (group 1) had wound infection compared with 7 (77.7%) of the 9 patients with nephrostomy (group 2) (P <0.05). All 9 group 2 patients had infected urine compared with 11 of the 22 in group 1 (P <0.05). Complications were apparent within a median time of 1 month (±SD 0.9) from surgery in group 2, whereas the median time to complication was 4.5 months (±SD 3.7, P <0.05) in group 1. Two patients in group 2 died of wound infection and sepsis. Both groups were similarly matched for age, indication for nephrostomy and nephrectomy, perioperative and operative techniques, and histologic findings of the removed kidneys. All patients received antibiotic agents at the time of surgery. Conclusions. Patients with nephrostomy inserted because of pyonephrosis or to relieve obstruction who underwent simple nephrectomy because of unrecoverable renal damage had earlier and more frequent wound infections than patients who underwent the identical procedure without nephrostomy.