Predictors of emergency department attendance following ureterorenoscopy for urolithiasis
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ORIGINAL ARTICLE
Predictors of emergency department attendance following ureterorenoscopy for urolithiasis Eoin MacCraith 1 & John O’Kelly 1 & James Ryan 1 & James C. Forde 1 & Ijaz Cheema 1 & Liza McLornan 1 & Niall F. Davis 1 Received: 27 February 2020 / Accepted: 23 March 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background We sought to determine the rate of emergency department (ED) attendance for complications after ureterorenoscopy (URS) for stone disease and to identify risk factors for ED attendance after URS. Methods An analysis of all patients undergoing URS over 12 months at a single institution was performed. Patient demographics, preoperative and intraoperative variables associated with postoperative complications and subsequent ED attendance were collected. Logistic regression analyses were performed to determine predictors of URS complications presenting to ED. Results In total, 202 ureteroscopies were performed on 142 patients for urolithiasis. The mean age was 50.73 ± 13.93 and 66% were male. The incidence of re-presentation to ED was 14.8% (n = 30). Patients presented with postoperative pain (n = 10; 4.95%), pyrexia (n = 9; 4.46%), urinary tract infection (UTI) (n = 7, 3.47%), haematuria (n = 3, 1.49%) and urosepsis (n = 1; 0.5%). Significant risk factors for ED attendance included preoperative stent dwell time > 30 days (P = 0.004), recently treated positive preoperative urine culture (P < 0.0001), stone size ≥ 13 mm (P = 0.043), stone location mid-ureter (P = 0.036) and female gender (P = 0.005). The following factors did not predict ED attendance, stent omission, access sheath utilization and operation duration. Conclusion Risk factors for ED attendance after URS include prolonged pre-stent dwell time, stone size ≥ 13 mm, treatment for a positive preoperative urine culture, mid-ureteric stone location and female gender. Urologists should be aware of these findings to decrease the risk of emergency re-presentation after elective URS surgery. Keywords Complications . Emergency department . Stones . Ureteroscopy
Abbreviations ED Emergency department URS Ureterorenoscopy UTI Urinary tract infection
Introduction Rigid and flexible ureterorenoscopy (URS) is commonly performed for treating urinary tract calculi and day-case URS has a low readmission rate of 5% [1]. Although the rate of readmission following URS is low, re-presentation to the ED is ≥ 15% and this places an increased burden on hospital resources [2]. The most common cause for ED attendance after URS * Eoin MacCraith [email protected] 1
Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
(not requiring admission) is pain, and the most common causes of inpatient admission are pyrexia and pain not controlled with oral analgesia [2]. Patients are less likely to attend ED if they have a preoperative stent and are more likely to be readmitted if they are comorbid [2]. The overall complication rate after URS is approximately 7% as described in one large series of 11,885 patients [3]. The rate
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