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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Blackwell, RH; Barton, GJ; Kothari, AN; Zapf, MAC; Flanigan, RC; Kuo, PC; Gupta, GN

Published Date

  • July 2016

Published In

Volume / Issue

  • 196 / 1

Start / End Page

  • 124 - 130

PubMed ID

  • 26804754

Pubmed Central ID

  • 26804754

Electronic International Standard Serial Number (EISSN)

  • 1527-3792

International Standard Serial Number (ISSN)

  • 0022-5347

Digital Object Identifier (DOI)

  • 10.1016/j.juro.2016.01.056

Language

  • eng