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Objective <p>This systematic review and meta-analysis aims to evaluate the association between the preoperative Mayo Adhesive Probability (MAP) score and key perioperative outcomes in patients undergoing percutaneous nephrolithotomy (PCNL).</p> Methods <p>A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from inception until October 2025 for studies comparing PCNL outcomes between patients with low (MAP &lt; 3) and high (MAP ≥ 3) MAP scores. The primary outcome was postoperative fever (&gt; 38&#xa0;°C within 48&#xa0;h). Secondary outcomes included hemoglobin (Hb) drop (as a continuous measure and as a binary outcome of ≥ 2&#xa0;g/dL), operative time, and hospital stay. Meta-analyses followed a pre-specified analysis plan, utilizing random-effects models for outcomes with substantial heterogeneity (I<sup>2</sup> &gt; 50%) and fixed-effect models otherwise. The certainty of evidence was graded using the GRADE approach.</p> Results <p>Six retrospective cohort studies (n = 1,364 patients) were included. The pooled analysis under the random-effects model showed no statistically significant association between a high MAP score (≥ 3) and the risk of postoperative fever (RR: 2.716, 95% CI: 0.738–9.997) or a significant Hb drop of &gt; 2&#xa0;g/dL (RR: 1.530, 95% CI: 0.789–3.083). Similarly, no significant differences were found for continuous Hb drop (SMD: 0.379, 95% CI: − 0.836–1.593), operative time (SMD: 0.154, 95% CI: − 0.003–0.312), or length of hospital stay (SMD: 0.137, 95% CI: − 0.076–0.350). However, considerable heterogeneity was observed for fever and Hb drop outcomes (I<sup>2</sup> &gt; 80%). The certainty of evidence was rated as low for fever and Hb drop, and moderate for operative time and hospital stay.</p> Conclusion <p>This meta-analysis does not confirm a statistically significant association between a high MAP score and adverse perioperative outcomes in PCNL when accounting for between-study heterogeneity. The observed trends and substantial heterogeneity underscore the need for cautious interpretation and highlight the necessity for standardized, high-quality prospective studies to definitively establish the role of the MAP score in PCNL preoperative planning.</p>

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The predictive value of Mayo adhesive probability (MAP) score for perioperative outcomes in percutaneous nephrolithotomy (PCNL): a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月4日

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  • Baian Wei,
  • Lu Wang,
  • Junwei He,
  • Yuan Li,
  • Fanhang Meng

摘要

Objective

This systematic review and meta-analysis aims to evaluate the association between the preoperative Mayo Adhesive Probability (MAP) score and key perioperative outcomes in patients undergoing percutaneous nephrolithotomy (PCNL).

Methods

A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from inception until October 2025 for studies comparing PCNL outcomes between patients with low (MAP < 3) and high (MAP ≥ 3) MAP scores. The primary outcome was postoperative fever (> 38 °C within 48 h). Secondary outcomes included hemoglobin (Hb) drop (as a continuous measure and as a binary outcome of ≥ 2 g/dL), operative time, and hospital stay. Meta-analyses followed a pre-specified analysis plan, utilizing random-effects models for outcomes with substantial heterogeneity (I2 > 50%) and fixed-effect models otherwise. The certainty of evidence was graded using the GRADE approach.

Results

Six retrospective cohort studies (n = 1,364 patients) were included. The pooled analysis under the random-effects model showed no statistically significant association between a high MAP score (≥ 3) and the risk of postoperative fever (RR: 2.716, 95% CI: 0.738–9.997) or a significant Hb drop of > 2 g/dL (RR: 1.530, 95% CI: 0.789–3.083). Similarly, no significant differences were found for continuous Hb drop (SMD: 0.379, 95% CI: − 0.836–1.593), operative time (SMD: 0.154, 95% CI: − 0.003–0.312), or length of hospital stay (SMD: 0.137, 95% CI: − 0.076–0.350). However, considerable heterogeneity was observed for fever and Hb drop outcomes (I2 > 80%). The certainty of evidence was rated as low for fever and Hb drop, and moderate for operative time and hospital stay.

Conclusion

This meta-analysis does not confirm a statistically significant association between a high MAP score and adverse perioperative outcomes in PCNL when accounting for between-study heterogeneity. The observed trends and substantial heterogeneity underscore the need for cautious interpretation and highlight the necessity for standardized, high-quality prospective studies to definitively establish the role of the MAP score in PCNL preoperative planning.