the presence of preoperative bacteriuria (p0.001), renal stone. (p0.013), use of access ... and chill, flank pain and costovertebral angle tenderness. There were.
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THE JOURNAL OF UROLOGY姞
1062 SOCIOECONOMIC TRENDS AND UTILIZATION IN THE EMERGENCY DEPARTMENT TREATMENT OF URINARY TRACT INFECTIONS Jesse D Sammon*, Khurshid R Ghani, Shyam Sukumar, Detroit, MI; Al’a Abdo, Orchidee Djahangirian, Montreal, Canada; Wooju Jeong, samantha staley, James O Peabody, Detroit, MI; Shahrokh F Shariat, New York, NY; Pierre I Karakiewicz, Maxine Sun, Montreal, Canada; Mani Menon, Detroit, MI; Quoc-Dien Trinh, Montreal, Canada INTRODUCTION AND OBJECTIVES: The cost of outpatient clinic treatment of urinary tract infections (UTI) has been estimated at $300, per episode, including office visit and laboratory fees. In this study we examined the populations most likely to be treated and released (T&R) from the emergency department (ED) and estimated the economic burden of ED treatment for this condition, using a U.S. population-based cohort. METHODS: A national weighted estimate of 10,799,345 patients with a primary diagnosis of UTI presented to the ED from January 1, 2006 - December 31, 2009 and was abstracted from the Nationwide Emergency Department Sample (NEDS). The NEDS is the largest all-payer ED database in the United States containing a 20% stratified sample of US hospital based EDs. Patients who were T&R were examined for ED charges, hospital and demographic characteristics. RESULTS: Between 2006 and 2009, 10.8 million patients presented to the ED in the U.S. for treatment of a UTI. 8.8 million (81.4%) were in the T&R population (2.0 million to 2.3 million per year, p⬍0.001). Relative to those admitted, this population was younger [median age: 32 (IQR: 21 to 54) vs. 72 (IQR: 46 to 84], more likely female (86.9 vs. 73.1%, p⬍0.001); on Medicaid (24.4 vs. 13.0%) or Private insurance (32.6 vs. 17.6%) p⬍0.001 and was more likely in the lowest income quartile (33.5 vs. 28.7%, p⬍0.001). Median ED charges for the T&R population were $1,072 per ED visit (IQR: 593 to 2,306.5). In comparison to UTI treatment charges in an outpatient setting, this represents a $772 (IQR: 293 to 2,006.5) average increase in the cost of treatment, per episode. The total differential cost nationwide was 1.6 billion dollars in 2006, increasing to 1.8 billion dollars in 2009. CONCLUSIONS: The number of patients treated and released for a UTI from US emergency rooms increased from 2.0 million in 2006 to 2.3 million in 2009. Improved guidelines and greater access to primary care physicians for these patients could result in annual cost savings of nearly 2 billion dollars. Source of Funding: None
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
RESULTS: Mean operating time was 81.8⫾3.9 min in TUL group and 26.5⫾1.6 min in USI group. Prevalence of f-UTI was 11.6% in TUL group and 13.6% in USI group. Univariate analysis revealed that the presence of preoperative bacteriuria (p⬍0.001), renal stone (p⫽0.013), use of access sheath during lithotripsy (p⫽0.025), history of f-UTI (p⫽0.032) and operating time (p⫽0.008) had a significant relationship with f-UTI in TUL group. Multivariate logistic regression analysis revealed that operating time and preoperative bacteriuria were risk factors for f-UTI after TUL (Table1). In USI group, there was no single factor that had a significant relationship with f-UTI. However, among cases of USI group, those with both positive preoperative bacteriuria and persistent hydronephrosis after ureteroscopy had more than 2.5 times larger risk for f-UTI compared with other cases. CONCLUSIONS: The reason why there were no significant risk factors for f-UTI in USI group might be explained by considerably short operating time compared to TUL group. When TUL is to be performed, reducing operating time is an important factor to prevent postoperative f-UTI especially in those cases with positive bacteriuria and renal stone. Table 1. univariate and multivariate analysis of factors elicitting f-UTI after transurethral lithotripsy univariate univariate multivariate multivariate analysis analysis analysis analysis OR P value OR P value age 1.03 .192 sex
0.56
.324
-
-
size of calculi
1.05
.141
-
-
preoperative ESWL
0.35
.328
-
-
preoperative bacteriuria
14.10
.001
16.70
.001
history of f-UTI
4.73
.012
-
-
ranal stone
0.22
.02
-
-
diabetes mellitus
0.43
.436
-
-
access seath
3.65
.032
-
-
perforation
0.67
.71
-
-
postoperative ureteral stenting
1.14
.872
-
operating time 1.02 .012 1.02 ESWL: Extracorporeal shock wave lithotripsy, OR: odds ratio
.018
Source of Funding: None
1064 CAN COMPUTERIZED TOMOGRAPHY (CT) SCANS FOR ACUTE PYELONEPHRITIS BE USEFUL FOR PREDICTING THE TREATMENT OUTCOME?
1063 PREDICTIVE FACTOR FOR FEBRILE URINARY TRACT INFECTION AFTER URETEROSCOPIC PROCEDURES Masafumi Kita*, Masaki Watanabe, Kazumi Hashizume, Tatsuya Iwata, Seiji Matsumoto, Hidehiro Kakizaki, Asahikawa, Japan INTRODUCTION AND OBJECTIVES: Febrile urinary tract infection (f-UTI) is a major complication associated with ureteroscopic procedures and, in some cases, leads to a life-threatening event. However there have been few reports investigating factors influencing the prevalence of f-UTI after diagnostic and therapeutic ureteroscopy. The aim of this study is to clarify predictive valuables of f-UTI related to ureteroscopic procedures. METHODS: A retrospective review of the medical records of 215 consecutive patients undergoing ureteroscopic procedures was performed. These cases were divided into two groups: transurethral lithotripsy (TUL) group (112 cases, 66 males and 46 females, mean age 63.2⫾1.3 years) and ureteroscopic investigation (USI) group (103 cases, 56 males and 47 females, mean age 69.1⫾1.3 years). Risk factors for f-UTI were evaluated using univariate and multivariate analysis.
Seung Hwan Lee*, Kwang Hyun Kim, Kyung Kgi Park, Dong Hoon Lee, Byung Ha Chung, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Many cases of acute pyelonephritis (APN) show renal perfusion defects on contrast enhanced computerized tomography (CT) imaging studies. We investigated the frequency of renal perfusion defects in uncomplicated APN and compared the clinical responses according to degree of renal perfusion defects. METHODS: We studied patients who had symptoms and signs of acute pyelonephritis through CT examinations with contrast enhancement. We identified 373 cases who had perfusion defects among 402 patients who had undergone CT imaging studies. We classified CT findings of group 1 as focal unilateral, multifocal unilateral (group 2) and multifocal bilateral (group 3) and compared the clinical data and factors influencing treatment outcome. RESULTS: Most patients were women (N⫽366, 98%) and had typical symptoms and signs of APN (N⫽361, 97%) such as high fever and chill, flank pain and costovertebral angle tenderness. There were 139 (37.3%) of 373 cases in group 1, 172 (47.6%) in group 2 and 62 (16.6%) in group3. On urinalysis, 241(64.6%) cases had positive bacterial cultures with Escherichia coli 179 (48.1%) being the most common pathogen. All the patients were treated with broad-spectrum
