Ureteral Stent Decompression is Associated with Decreased Length of Stay in Obstructive, Infected Ureteral Stones
Video
Team Information
Team Members
Albert Ha, Resident Physician, Department of Urology, CUIMC
Greg Hruby, Program Director of Research, Department of Analytics, New York Presbyterian Department of Analytics
David Han, Resident Physician, Department of Urology, CUIMC
Rainjade Chung, Resident Physician, Department of Urology, CUIMC
Jeffrey Johnson, MD; Weill Cornell Medical College, Department of Urology; Resident Physician
Isaac H Michaels, MPH; New York Presbyterian Department of Analytics
Timothy McClure, MD, MPH; Assistant Professor of Urology; Weill Cornell Medical College, Department of Urology
Faculty Advisor: Ojas Shah, George F. Cahill Professor of Urology, College of Physicians and Surgeons, Columbia University
Abstract
Introduction and Objective
Obstructive, infected ureteral stones are urologic emergencies requiring prompt decompression. Few studies with adequate power and granular data to compare decompression via ureteral stent vs. nephrostomy tube currently exist. As such, the understanding of the comparative efficacy of these two procedures remains ambiguous.
Methods
Using the New York Presbyterian enterprise data warehouse (2012-2020) from two large, urban academic centers, we identified 1,932 patients with an Emergency Department (ED) visit for an obstructive ureteral stone. 520 patients with documented positive urine cultures and ureteral decompression via stent or nephrostomy tube (PCN) were subsequently analyzed. To reduce selection bias, a random sample of 100 intensive care unit (ICU), 150 positive blood culture, and 200 length of hospital stay (LOS) ≥4 days cases and 200 corresponding controls were selected for respective outcomes. Backwards stepwise logistic regression was performed and known confounders were subsequently added to construct multivariable models of best fit.
Results
On multivariate analysis, ureteral stent decompression was associated with LOS <4 days (OR: 0.37; p<0.001) and decreased odds of positive blood cultures (OR: 0.51; p=0.021) but not ICU utilization (OR: 0.63; p = 0.16) when compared to PCN [Figure 1B]. Increased time to decompression was associated with increased LOS (OR: 1.03; p<0.001), and greater Charlson Comorbidity Index (CCI) was associated with ICU utilization (OR 1.09; p = 0.040). Positive sepsis criteria were associated with increased odds of ICU utilization (OR: 4.32; p<0.001) and positive blood cultures (OR: 2.67; p<0.001).
Conclusion
Sepsis criteria, prolonged time to decompression, and CCI were associated with worse outcomes in patients with obstructive, infected ureteral calculi. While stent placement was associated with reduced likelihood of positive cultures, we hypothesize that underlying surgical selection on part of the urologist may be involved. Further investigation of the underlying methodologies of management is warranted. Most importantly, despite controlling for multiple factors, stent utilization was associated with reduced length of stay.
Team Lead Contact
Albert Ha: ah3512@cumc.columbia.edu
