Herout R. et al., 2023: Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay.
Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Abstract
Purpose: To assess differences in the length of hospital stay (LOS) in patients who present emergently versus electively for a symptomatic ureteral stone and to explore underlying risk factors.
Methods: Billing data were analyzed from patients with symptomatic ureteral calculi at our department from 2010 to 2021. Statistical analysis (U test, logistic regression) was performed.
Results: 2274 patients (72% male, 28% female) with ureteral stones were analyzed (mean age of 52.9y). 1578 patients (69.4%) presented in an emergency setting and 696 patients (30.6%) electively. Arterial hypertension was seen in 31%, diabetes mellitus in 11% and hyperuricemia in 5% of the whole cohort. 46.5% of emergency patients were desobstructed (DJ/PCN), 35.4% underwent emergency ureteroscopy (URS), 13.4% had spontaneous passage (SP), and 4.8% underwent emergency shock wave lithotripsy (SWL). Of the electively treated patients, 58.6% underwent URS, 21.3% SWL, 18.5% DJ/PCN, and 1.6% had SP. Emergency stone treatment was associated with a significantly longer LOS when compared to primary desobstruction for patients admitted emergently. Also, LOS was significantly longer for each intervention of stone treatment in emergency patients vs. electively treated patients. Arterial hypertension was associated with a 1.8-fold increased risk of a hospital stay longer than 3 days, irrespective of hospital admission mode, whereas metabolic disorders did not influence LOS in this cohort.
Conclusion: For emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay. Arterial hypertension is an independent significant risk factor for prolonged hospital stay.
Int Urol Nephrol. 2023 Dec;55(12):3039-3044. doi: 10.1007/s11255-023-03749-0. Epub 2023 Aug 24. PMID: 37615842; PMCID: PMC10611860.
Comments 1
I do not think that the way the data are presented justifies this conclusion: “For emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay.” A causal relationship is not shown. All emergency patients had a longer hospital stay compared to the elective group. Emergency patients had to be prepared for the procedure during their stay while elective patients were already prepared when hospitalized. Why and which surgical procedure was chosen may have more impact on the LOS and it is not differentiated if the pre- or postprocedural stay was longer. It’s all statistics but not causes.
Peter Alken