Introduction: Our objective was to identify factors that increase a patient’s risk of emergency room visits and readmission in the immediate postoperative period.
Methods: An IRB approved prospectively maintained surgical database of patients with renal and ureteral stones at a regional referral center was retrospectively analyzed for consecutive ureteroscopies with 30 days follow-up from 2016 to 2019. We selected the most recent 500 cases (250 consecutive women and 250 consecutive men). Stone size was determined by preoperative imaging. Gender, comorbidities (HTN, gout, BMI, diabetes, chronic UTIs, CKD, bowel disease), preoperative visits to the emergency room within 30 days and surgical factors (preoperative stent, stone size) were used to conduct chi squared univariate analysis. Outcome measures were emergency room visit within 30 days and admission within 30 days. Exclusion criteria included age <18, less than 30 days follow-up.
Results: Of the 500 patents, 25 (5%) visited the emergency room within 30 days postoperatively and 12 (2.4%) were admitted postoperatively within 30 days. No factors were associated with emergency room visits post operatively (all p>0.05). Preoperative stenting (p=0.34), stone size (p=0.65), gender (p=0.24), BMI (p=0.56), diabetes (p=0.86), gout (p=0.51) and bowel disease (p=0.45) were not associated with postoperative admissions. Patients were less likely to have postoperative admission if they had a preoperative emergency room visit (3.6% vs 0.0%; p=0.02). Patients were more likely to have a postoperative admission if they had a history of HTN (1.0% vs 4.3%; p=0.02), chronic UTIs (1.9% vs 12.5%; p<0.01) and CKD (2.0% vs 7.3%; p=0.03).
Conclusions: We identified 3 comorbidities that place patients at increased risk for readmission after ureteroscopy. Hypertension(p<0.02), history of chronic UTIs(p<0.01) and CKD(p<0.03) increase the likelihood a patient will be admitted within 30 days. These patients should be targeted in interventions to prevent readmission. Source of
