Obstructive pyelonephritis is considered a urologic emergency, but there is limited evidence regarding the importance of prompt decompression. We sought to investigate whether delay in decompression is an independent predictor of in-hospital mortality. Secondarily, we aimed to determine the impact of patient, hospital, and disease factors on the likelihood of receipt of delayed vs prompt decompression.
Using the National Inpatient Sample from 2010-2015, all patients 18 years or older with ICD-9 diagnosis of urinary tract infection (UTI) who had either a ureteral stone or kidney stone with hydronephrosis (n = 311,100) were identified. Two weighted sample multivariable logistic regression models assessed predictors both of the primary outcome of death in the hospital and secondly, predictors of delayed decompression (≥2 days after admission).
After controlling for patient demographics, comorbidity, and disease severity, delayed decompression significantly increased odds of death by 29%. (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.03-1.63, p = 0.032). Delayed decompression was more likely to occur with weekend admissions (OR 1.22, 95% CI 1.15-1.30, p < 0.001), non-white race (OR 1.34, 95% CI 1.25-1.44, p < 0.001), and lower income demographic (lowest income quartile OR 1.25, 95% CI 1.14-1.36, p < 0.001).
While the overall risk of mortality is fairly low in patients with obstructing upper urinary tract stones and UTI, a delay in decompression increased odds of mortality by 29%. The increased likelihood of delay associated with weekend admissions, minority patients, and lower socioeconomic status suggests opportunities for improvement.
The Journal of urology. 2020 Jun 05 [Epub ahead of print]
Christopher R Haas, Gen Li, Elias S Hyams, Ojas Shah
Columbia University Irving Medical Center Department of Urology, New York, New York., Columbia University Mailman School of Public Health, New York, New York.