Timing of Upper Urinary Tract Stone Surgery after Initial Presentation for Renal Colic with Concomitant Urinary Infection.

OBJECTIVE: We investigated the effect of timing to stone surgery on perioperative outcomes and costs for patients who presented with renal colic and concomitant urinary tract infection (UTI). METHODS: The 2018 Healthcare Utilization Project databases were used to identify patients who presented with renal colic and underwent upper urinary tract stone surgery within 3 months. Patients were stratified by infection status at presentation and time to surgery. Binary logit model and ordered logistic regressions with average marginal effect were used to estimate the odds of 30-day post-operative revisit based on time to surgery, evaluate surgical timing on probability of cost quartiles, and identify variables associated with surgical timing. RESULTS: There were 11,695 total patients, 1654 (14%) with UTI and 914 (8%) with sepsis. Time to surgery was not associated with differences in 30-day post-operative revisit for either infection group. Total episode-related costs were higher when surgery occurred >4 weeks, and pre-operative costs were higher for all groups compared to surgery within 1 week (p<0.001). UTI and sepsis showed a 7.2 and 11.4 %-point increased probability, respectively, of surgery occurring at >4 weeks (p<0.001). CONCLUSIONS: We found no benefit in delaying surgery with respect to 30-day post-operative revisits for patients presenting with renal colic and concomitant UTI. Delays led to higher total episode-related costs, largely driven by the pre-operative period. UTI at presentation was associated with delays in surgery, and our findings illustrate the importance of future prospective studies evaluating the impact of surgical timing on patients with urolithiasis and UTI.

Duke Scholars

Author Charles Douglas Scales Jr. Urology