Presentation Authors: Christopher R Haas*, Gen Li, Marla Wardenburg, Kelly A Healy, Elias S Hyams, Ojas Shah, New York, NY
Introduction: Obstructive pyelonephritis is a urologic emergency warranting prompt decompression. While decompression in septic patients is associated with improved survival, there is limited evidence regarding the importance of time to decompression. We investigated whether time to intervention was an independent predictor of in-hospital mortality.
Methods: Using the National Inpatient Sample (NIS) spanning 2010-2015, we identified all patients 18yrs or older with ICD-9 diagnoses of UTI who had either ureteral stone or kidney stone with hydronephrosis. We excluded patients with elective admissions and those who had any additional endoscopic urologic procedure other than decompression. Time to decompression with retrograde ureteral stent (RUS) or nephrostomy tube (NT) was measured in days from admission day (0 indicating decompression on day of admission). Patients with decompression >7 days were excluded. Weighted sample multivariable logistic analysis assessed predictors of death in the hospital.
Results: There were 374,789 weighted discharges for stone-related obstructing pyelonephritis from 2010 to 2015. The % that were decompressed and mortality rates trended upward with sepsis severity (Table 1), while time to decompression did not trend with sepsis severity. After controlling for patient age, sex, Elixhauser comorbidity score, sepsis category, NT vs RUS, and nine measures of organ failure, time to decompression was found to be a significant predictor of death with a 10% increased odds of death for each additional day to decompression (OR 1.10, p = 0.001). Among only those decompressed patients with any degree of sepsis (n = 92,661), time to decompression remained significant on multivariable analysis (OR 1.08, p = 0.020). Within these analyses, undergoing NT over RUS was associated with increased odds of mortality in the total cohort (OR 1.36, p = 0.005) and in the septic only cohort (OR 1.31, p = 0.015).
Conclusions: For each additional day to surgical decompression for obstructive pyelonephritis from stones, there is a 10% increased odds of in-hospital mortality. Prompt decompression of this condition is critical to patient outcomes.