Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice
Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice
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DOI：
10.1016/j.juro.2016.01.056
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发表时间：
2016-07-01
影响因子：
6.6
通讯作者：
Gupta, Gopal N.
中科院分区：
文献类型：
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作者：
Blackwell, Robert H.;Barton, Gregory J.;Gupta, Gopal N.
目的：梗阻性肾结石是一种常见疾病，需要紧急干预。在本研究中，我们分析了急性结石入院期间导致延迟干预的患者因素。 材料和方法：我们回顾性审查了 2007 年至 2011 年佛罗里达州和加利福尼亚州的 HCUP SID（医疗费用和利用项目州住院患者数据库）。研究中包括因肾结石紧急入院且有减压指征（尿路感染、急性肾功能不全和/或脓毒症）的患者。干预是及时的或延迟的，分别定义为 48 小时内或之后发生的程序。调整后的多变量模型适合评估预测手术延迟和死亡率的因素。结果：总共有 10,301 名患者因肾结石紧急入院，有减压指征。与延迟干预（3,612 名患者中的 17 名患者，0.47%，p=0.002）相比，早期干预发生在 6,689 名患者（65%）中，与死亡率降低相关（11 名患者，0.16%）。多变量分析显示，及时干预显着降低了住院患者死亡率（OR 0.43，p=0.044）。周末入院显着影响干预时间，使患者及时干预的几率降低 26% (p
Purpose: Obstructing nephrolithiasis is a common condition that can require urgent intervention. In this study we analyze patient factors that contribute to delayed intervention during acute stone admission.Materials and Methods: We retrospectively reviewed the HCUP SID (Healthcare Cost and Utilization Project State Inpatient Database) for Florida and California from 2007 to 2011. Patients who were admitted urgently with nephrolithiasis and an indication for decompression (urinary tract infection, acute renal insufficiency and/or sepsis) were included in the study. Intervention was timely or delayed, defined as a procedure that occurred within or after 48 hours, respectively. Adjusted multivariate models were fit to assess factors that predicted a delayed procedure as well as mortality.Results: Overall 10,301 patients were admitted urgently for nephrolithiasis with indications for decompression. Early intervention occurred in 6,689 patients (65%) and was associated with a decrease in mortality (11, 0.16%), compared to delayed intervention (17 of 3,612, 0.47%, p=0.002). On multivariate analysis timely intervention significantly decreased the odds of inpatient mortality (OR 0.43, p=0.044). Weekend day admission significantly influenced time to intervention, decreasing patient odds of timely intervention by 26% (p