Abstract / Summary
Systemic inflammatory response syndrome (SIRS)-defined postoperative sepsis is a rare but serious complication after flexible ureteroscopy (FURS) for upper urinary tract stones. Existing prediction tools are often too complex for bedside use. This single-centre retrospective study included 1317 adults undergoing FURS, randomly split 70:30 into training and internal validation cohorts. SIRS-defined postoperative sepsis within 48 h was defined using systemic inflammatory response criteria rather than Sepsis-3 criteria because complete SOFA components were not consistently available. Independent predictors identified by logistic regression were used to construct a simplified perioperative bedside risk score, which was linked to a proposed risk-adapted management framework. SIRS-defined postoperative sepsis occurred in 82 patients (6.2%). Six independent predictors (female sex, positive urine culture, stone size ≥ 2 cm, staghorn stone, preoperative albumin < 35 g/L, operative time ≥ 60 min) formed the bedside score. The score showed good discrimination (AUC > 0.85 in both cohorts), satisfactory calibration, and favourable net benefit. SIRS-defined postoperative sepsis incidence increased stepwise across low- (2.1%), intermediate- (6.1%) and high-risk (21.7%) strata. A simplified perioperative bedside score based on six routinely available variables provides an internally validated tool for SIRS-defined postoperative sepsis risk stratification after FURS. The proposed risk-adapted management framework is hypothesis-generating, and prospective external validation is warranted.