Predictors and Health Care Utilization of Sepsis Post-Ureteroscopy in a US-Based Population: Results from the Endourological Society TOWER Collaborative

Purpose: To investigate the incidence, predictive factors, and health care utilization of sepsis post-ureteroscopy (URS) in patients enrolled in commercial insurance plans. Materials and Methods: A retrospective claims analysis was conducted using the IBM (R) MarketScan (R) commercial database. Patients >= 18 years were included if they had URS between January 2015 and October 2019 and developed sepsis within 30 days of URS. Multivariate logistic regression was used to identify various clinical and demographic predictors of sepsis post-URS. All-cause health care utilization (i.e., inpatient admissions and intensive care unit [ICU] stays) and all-cause health care costs up to 1 month post-septic event were measured. Results: Among the 104,100 URS patients meeting the inclusion criteria, 5.5% developed sepsis. Patients with diabetes (odds ratio [OR] = 1.52; p < 0.0001), older age (age 55-64 vs 18-34; OR =1.35; p < 0.0001), baseline sepsis (OR= 3.51; p < 0.0001), baseline inpatient visits (OR = 1.17; p = 0.0012), and higher Elixhauser comorbidity scores (OR = 1.09; p < 0.0001) had a significantly higher likelihood of developing sepsis post-URS. In septic patients, 94.8% required inpatient care and 35% were admitted to the ICU. Mean hospital stay for septic patients was 6.86 days. Average all-cause health care cost per patient at 1 month in the septic cohort was $49,625 vs $17,782 in the nonseptic cohort indicating an incremental all-cause cost of $31,843 (p < 0.0001). Conclusions: A total of 5.5% of commercially insured patients undergoing URS developed sepsis post-URS. Diabetes, older age, baseline sepsis, baseline inpatient visit, and higher comorbidity score were all found to be independent predictors of post-URS sepsis. Patients with sepsis post-URS had higher health care utilization and costs indicating that sepsis is both a significant clinical and economic event.