Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice. J Urol 2016 Jul;196(1):124-30
Date
01/26/2016Pubmed ID
26804754Pubmed Central ID
PMC5207476DOI
10.1016/j.juro.2016.01.056Scopus ID
2-s2.0-84969514475 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
PURPOSE: Obstructing nephrolithiasis is a common condition that can require urgent intervention. In this study we analyze patient factors that contribute to delayed intervention during acute stone admission.
MATERIALS AND METHODS: We retrospectively reviewed the HCUP SID (Healthcare Cost and Utilization Project State Inpatient Database) for Florida and California from 2007 to 2011. Patients who were admitted urgently with nephrolithiasis and an indication for decompression (urinary tract infection, acute renal insufficiency and/or sepsis) were included in the study. Intervention was timely or delayed, defined as a procedure that occurred within or after 48 hours, respectively. Adjusted multivariate models were fit to assess factors that predicted a delayed procedure as well as mortality.
RESULTS: Overall 10,301 patients were admitted urgently for nephrolithiasis with indications for decompression. Early intervention occurred in 6,689 patients (65%) and was associated with a decrease in mortality (11, 0.16%), compared to delayed intervention (17 of 3,612, 0.47%, p=0.002). On multivariate analysis timely intervention significantly decreased the odds of inpatient mortality (OR 0.43, p=0.044). Weekend day admission significantly influenced time to intervention, decreasing patient odds of timely intervention by 26% (p <0.001). Other factors decreasing patient odds of timely intervention included nonCaucasian race and nonprivate insurance. Presenting medical diagnoses of urinary tract infection, sepsis and acute renal failure did not appear to influence time to intervention.
CONCLUSIONS: Delayed operative intervention for acute nephrolithiasis admissions with indications for decompression results in increased patient mortality. Nonmedical factors such as the "weekend effect," race and insurance provider exerted the greatest influence on the timing of intervention.
Author List
Blackwell RH, Barton GJ, Kothari AN, Zapf MA, Flanigan RC, Kuo PC, Gupta GNAuthor
Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute DiseaseAdult
After-Hours Care
Aged
California
Cross-Sectional Studies
Decompression, Surgical
Delayed Diagnosis
Emergencies
Female
Florida
Humans
Logistic Models
Male
Middle Aged
Nephrolithiasis
Patient Admission
Practice Patterns, Physicians'
Retrospective Studies
Socioeconomic Factors
Time Factors
Treatment Outcome
Urologic Surgical Procedures
