Christopher R Haas1, Gen Li2, Elias S Hyams1, Ojas Shah1. 1. Columbia University Irving Medical Center Department of Urology, New York, New York. 2. Columbia University Mailman School of Public Health, New York, New York.
Abstract
PURPOSE: Obstructive pyelonephritis is considered a urologic emergency, but there is limited evidence regarding the importance of prompt decompression. We sought to investigate whether delay in decompression is an independent predictor of in-hospital mortality. Secondarily, we aimed to determine the impact of patient, hospital, and disease factors on the likelihood of receipt of delayed vs prompt decompression. MATERIALS AND METHODS: Using the National Inpatient Sample from 2010-2015, all patients 18 years or older with ICD-9 diagnosis of urinary tract infection (UTI) who had either a ureteral stone or kidney stone with hydronephrosis (n = 311,100) were identified. Two weighted sample multivariable logistic regression models assessed predictors both of the primary outcome of death in the hospital and secondly, predictors of delayed decompression (≥2 days after admission). RESULTS: After controlling for patient demographics, comorbidity, and disease severity, delayed decompression significantly increased odds of death by 29%. (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.03-1.63, p = 0.032). Delayed decompression was more likely to occur with weekend admissions (OR 1.22, 95% CI 1.15-1.30, p < 0.001), non-white race (OR 1.34, 95% CI 1.25-1.44, p < 0.001), and lower income demographic (lowest income quartile OR 1.25, 95% CI 1.14-1.36, p < 0.001). CONCLUSIONS: While the overall risk of mortality is fairly low in patients with obstructing upper urinary tract stones and UTI, a delay in decompression increased odds of mortality by 29%. The increased likelihood of delay associated with weekend admissions, minority patients, and lower socioeconomic status suggests opportunities for improvement.
PURPOSE: Obstructive pyelonephritis is considered a urologic emergency, but there is limited evidence regarding the importance of prompt decompression. We sought to investigate whether delay in decompression is an independent predictor of in-hospital mortality. Secondarily, we aimed to determine the impact of patient, hospital, and disease factors on the likelihood of receipt of delayed vs prompt decompression. MATERIALS AND METHODS: Using the National Inpatient Sample from 2010-2015, all patients 18 years or older with ICD-9 diagnosis of urinary tract infection (UTI) who had either a ureteral stone or kidney stone with hydronephrosis (n = 311,100) were identified. Two weighted sample multivariable logistic regression models assessed predictors both of the primary outcome of death in the hospital and secondly, predictors of delayed decompression (≥2 days after admission). RESULTS: After controlling for patient demographics, comorbidity, and disease severity, delayed decompression significantly increased odds of death by 29%. (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.03-1.63, p = 0.032). Delayed decompression was more likely to occur with weekend admissions (OR 1.22, 95% CI 1.15-1.30, p < 0.001), non-white race (OR 1.34, 95% CI 1.25-1.44, p < 0.001), and lower income demographic (lowest income quartile OR 1.25, 95% CI 1.14-1.36, p < 0.001). CONCLUSIONS: While the overall risk of mortality is fairly low in patients with obstructing upper urinary tract stones and UTI, a delay in decompression increased odds of mortality by 29%. The increased likelihood of delay associated with weekend admissions, minority patients, and lower socioeconomic status suggests opportunities for improvement.
Authors: Daniel Pérez Fentes; Carlos Fernández Baltar; Juan Núñez Otero; Rita Diz Gil; Francisco Gude Sampedro Journal: Cent European J Urol Date: 2021-03-11