Objective <p>To evaluate the impact of intraoperative use of furosemide (FUR) in combination with dexamethasone (DEX) on postoperative complications following mini-percutaneous nephrolithotripsy (mini-PCNL).</p> Patients and methods <p>The study was a retrospective cohort analysis of adult patients with kidney calculi treated with mini-PCNL. Exposure was the intravenous administration of FUR and DEX during mini-PCNL. The primary outcome was postoperative fever (≥ 38°C), whereas the secondary outcomes were other complications. Propensity score matching (PSM) was performed at a 1:1 ratio. Subgroup analyses and interaction tests were used to examine differences among different demographic groups.</p> Results <p>The pre-matched and propensity score-matched cohorts included 237 and 166 patients, respectively. In the PSM cohort, postoperative fever (≥ 38°C) occurred in 8.4% (7/83) of the FUR + DEX group and 20.5% (17/83) of the control group. The combined use of FUR and DEX was associated with a lower postoperative fever (<i>P</i> = 0.027). There was no statistically significant difference between the FUR + DEX group and the control group for other complications, including SIRS, urosepsis, and pain-requiring opioids. SIRS occurred in 4.8% (4/83) of the FUR + DEX group versus 8.4% (7/83) in the control group, while urosepsis rates were 2.4% (2/83) versus 3.6% (3/83), respectively. Subgroup analysis showed a significant reduction in postoperative fever in patients with an operation time of ≥ 2 h in the FUR + DEX group, as indicated by the interaction test (<i>P</i> = 0.05).</p> Conclusion <p>The intravenous combined use of FUR and DEX in mini-PCNL reduces postoperative fever (≥ 38°C), particularly benefiting patients with an operative time of ≥ 2 h.</p>