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Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice.

Publication ,  Journal Article
Blackwell, RH; Barton, GJ; Kothari, AN; Zapf, MAC; Flanigan, RC; Kuo, PC; Gupta, GN
Published in: The Journal of urology
July 2016

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.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.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.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.

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Published In

The Journal of urology

DOI

EISSN

1527-3792

ISSN

0022-5347

Publication Date

July 2016

Volume

196

Issue

1

Start / End Page

124 / 130

Related Subject Headings

  • Urology & Nephrology
  • Urologic Surgical Procedures
  • Treatment Outcome
  • Time Factors
  • Socioeconomic Factors
  • Retrospective Studies
  • Practice Patterns, Physicians'
  • Patient Admission
  • Nephrolithiasis
  • Middle Aged
 

Citation

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Blackwell, R. H., Barton, G. J., Kothari, A. N., Zapf, M. A. C., Flanigan, R. C., Kuo, P. C., & Gupta, G. N. (2016). Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice. The Journal of Urology, 196(1), 124–130. https://doi.org/10.1016/j.juro.2016.01.056
Blackwell, Robert H., Gregory J. Barton, Anai N. Kothari, Matthew A. C. Zapf, Robert C. Flanigan, Paul C. Kuo, and Gopal N. Gupta. “Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice.The Journal of Urology 196, no. 1 (July 2016): 124–30. https://doi.org/10.1016/j.juro.2016.01.056.
Blackwell RH, Barton GJ, Kothari AN, Zapf MAC, Flanigan RC, Kuo PC, et al. Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice. The Journal of urology. 2016 Jul;196(1):124–30.
Blackwell, Robert H., et al. “Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice.The Journal of Urology, vol. 196, no. 1, July 2016, pp. 124–30. Epmc, doi:10.1016/j.juro.2016.01.056.
Blackwell RH, Barton GJ, Kothari AN, Zapf MAC, Flanigan RC, Kuo PC, Gupta GN. Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice. The Journal of urology. 2016 Jul;196(1):124–130.
Journal cover image

Published In

The Journal of urology

DOI

EISSN

1527-3792

ISSN

0022-5347

Publication Date

July 2016

Volume

196

Issue

1

Start / End Page

124 / 130

Related Subject Headings

  • Urology & Nephrology
  • Urologic Surgical Procedures
  • Treatment Outcome
  • Time Factors
  • Socioeconomic Factors
  • Retrospective Studies
  • Practice Patterns, Physicians'
  • Patient Admission
  • Nephrolithiasis
  • Middle Aged