Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi

被引:83
作者
Borofsky, Michael S.
Walter, Dawn
Shah, Ojas
Goldfarb, David S.
Mues, Adam C.
Makarov, Danil V.
机构
[1] NYU, Langone Med Ctr, Dept Urol, Div Nephrol, New York, NY 10016 USA
[2] NYU, Langone Med Ctr, Sect Value & Effectiveness, Dept Populat Sci, New York, NY 10016 USA
[3] New York Harbor Vet Affairs Healthcare Syst, Dept Urol, New York, NY USA
[4] New York Harbor Vet Affairs Healthcare Syst, Nephrol Sect, New York, NY USA
[5] NYU, Robert F Wagner Grad Sch Publ Serv, New York, NY 10016 USA
关键词
ureter; ureteral calculi; nephrolithiasis; sepsis; decompression; URINARY-TRACT CALCULI; PERCUTANEOUS NEPHROSTOMY; INFECTED HYDRONEPHROSIS; EMERGENCY DRAINAGE; UNITED-STATES; UROSEPSIS; MANAGEMENT; STONES;
D O I
10.1016/j.juro.2012.09.088
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention. Materials and Methods: Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression. Results: Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9-3.7). Conclusions: Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.
引用
收藏
页码:946 / 951
页数:6
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