BACKGROUND Same-session bilateral ureteroscopy may reduce the number of surgeries for stone removal but can lead to higher overall complication rates. We aimed to compare same-session bilateral ureteroscopy with unilateral ureteroscopy in terms of perioperative outcomes. METHODS We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We assessed, through multiple patient-level analyses, severe perioperative complications, mortality, length of hospital stay, hospital revenues, intensive care unit admission, and the evolution of ureteroscopy during the last years in Germany. RESULTS We included 833,609 patients undergoing either same-session bilateral (n = 6,914, 0.8%) or unilateral (n = 826,695, 99.2%) ureteroscopy for stone management. Patients undergoing bilateral ureteroscopy presented worse baseline characteristics. After adjusting for these characteristics, same-session bilateral ureteroscopy, compared to unilateral ureteroscopy, was significantly associated with higher odds of postoperative sepsis (OR: 2.4, 95%CI: 2-2.8, p<0.001), myocardial infarction (OR: 2, 95%CI: 1.03-3.5, p=0.024), acute kidney disease (OR: 2.8, 95%CI: 2.5-3.2, p<0.001), transfusion (OR: 4.2, 95%CI: 3.6-4.8, p<0.001), urinary tract infection (OR: 1.6, 95%CI: 1.5-1.7, p<0.001), intensive care unit admission (OR: 1.9, 95%CI: 1.6-2.3, p<0.001), and mortality (OR: 3.1, 95%CI: 2.1-4.5, p<0.001). Similarly, the length of hospital stay was longer, and the in-hospital costs were higher (p<0.001) after same-session bilateral ureteroscopy. Interestingly, the annual cases of ureteroscopy have undergone about a 3-fold increase in the last 17 years. CONCLUSIONS The present real-world data demonstrate that same-session bilateral ureteroscopy leads to higher rates of perioperative myocardial infarction, acute kidney disease, transfusion, urinary tract infections, sepsis, and intensive care unit admission, as well as to increased length of hospital stay, costs and inpatient mortality compared to unilateral ureteroscopy.

中文翻译：

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同次双侧输尿管镜取石术与单侧输尿管镜取石术的围手术期结果：GRAND 研究的结果。

背景同次双侧输尿管镜检查可以减少结石清除手术的数量，但可能导致更高的总体并发症发生率。我们的目的是比较同次双侧输尿管镜检查与单侧输尿管镜检查的围手术期结果。方法 我们使用由联邦统计局研究数据中心提供的德国全国住院患者数据 (GRAND)（2005-2021 年）。我们通过多个患者层面的分析，评估了德国过去几年的严重围手术期并发症、死亡率、住院时间、医院收入、重症监护病房入院情况以及输尿管镜的发展。结果 我们纳入了 833,609 名接受同次双侧（n = 6,914，0.8%）或单侧（n = 826,695，99.2%）输尿管镜检查以治疗结石的患者。接受双侧输尿管镜检查的患者表现出较差的基线特征。调整这些特征后，与单侧输尿管镜检查相比，同次双侧输尿管镜检查与术后脓毒症（OR：2.4，95％CI：2-2.8，p<0.001）、心肌梗死（OR：2 , 95%CI: 1.03-3.5, p=0.024), 急性肾病 (OR: 2.8, 95%CI: 2.5-3.2, p<0.001), 输血 (OR: 4.2, 95%CI: 3.6-4.8, p <0.001）、尿路感染（OR：1.6，95%CI：1.5-1.7，p<0.001）、入住重症监护病房（OR：1.9，95%CI：1.6-2.3，p<0.001）和死亡率（ OR：3.1，95%CI：2.1-4.5，p<0.001）。同样，同次双侧输尿管镜检查后，住院时间更长，住院费用更高（p<0.001）。有趣的是，在过去 17 年里，每年接受输尿管镜检查的病例增加了约 3 倍。结论 目前的真实数据表明，同次双侧输尿管镜检查会导致围手术期心肌梗死、急性肾病、输血、尿路感染、脓毒症和重症监护病房住院率升高，并延长住院时间与单侧输尿管镜检查相比，费用和住院患者死亡率。