Causes et facteurs prédictifs d’une hospitalisation postopératoire prolongée après urétéroscopie souple : expérience d’un centre hospitalo-universitaire

Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay

PURPOSE

To assess differences in the length of hospital stay (LOS) in patients who present emergently versus electively for a symptomatic ureteral stone and to explore underlying risk factors.

METHODS

Billing data were analyzed from patients with symptomatic ureteral calculi at our department from 2010 to 2021. Statistical analysis (U test, logistic regression) was performed.

RESULTS

2274 patients (72% male, 28% female) with ureteral stones were analyzed (mean age of 52.9y). 1578 patients (69.4%) presented in an emergency setting and 696 patients (30.6%) electively. Arterial hypertension was seen in 31%, diabetes mellitus in 11% and hyperuricemia in 5% of the whole cohort. 46.5% of emergency patients were desobstructed (DJ/PCN), 35.4% underwent emergency ureteroscopy (URS), 13.4% had spontaneous passage (SP), and 4.8% underwent emergency shock wave lithotripsy (SWL). Of the electively treated patients, 58.6% underwent URS, 21.3% SWL, 18.5% DJ/PCN, and 1.6% had SP. Emergency stone treatment was associated with a significantly longer LOS when compared to primary desobstruction for patients admitted emergently. Also, LOS was significantly longer for each intervention of stone treatment in emergency patients vs. electively treated patients. Arterial hypertension was associated with a 1.8-fold increased risk of a hospital stay longer than 3 days, irrespective of hospital admission mode, whereas metabolic disorders did not influence LOS in this cohort.

CONCLUSION

For emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay. Arterial hypertension is an independent significant risk factor for prolonged hospital stay.

Predictive factors of postoperative septic complications after flexible ureteroscopy for urinary stones

BACKGROUND

Flexible ureteroscopy (fURS) is one of the recommended treatments for urinary stones. Urosepsis is one of the most frequent complications of fURS however its predictive factors remain uncertain. Our objective was to assess the septic complications rates of fURS and to determinate predictive factors of these complications in patients undergoing fURS.

METHODS

Our retrospective analysis included all patients admitted for any fURS for stone disease in our center from December 2009 to April 2013. Patients' medical history, urine culture, stone composition, surgical and anesthetic characteristics were collected. The primary endpoint was defined by the presence of any septic complication (i.e. postoperative fever, urosepsis, septic shock or death). We used multivariate logistic regression to assess predictive factors of septic complication related to fURS.

RESULTS

Two hundred and eighty-two patients were included in this study. Urosepsis rate was 9.8% while 18.9% developed postoperative hyperthermia (>37.5°C). In multivariate analysis, the predictive risk factors of septic complication were: a neurologic disorder (OR=6.1; CI95%: 2.9-17.1), a history of urinary tract infection (UTI) (OR=19.6; CI95%: 7.3-52.1), exposure to peroperative nitrous oxide (OR=3.2; CI95%: 1.5-6.8) and intraoperative use of a laser (OR=8.0; CI95%: 13.0-30.3).

CONCLUSION

The use of fURS is associated with relatively frequent septic complications. Patients with neurologic disorders or a history of UTI carry an increased risk of postoperative complications. Limitations should be drawn with the use of peroperative nitrous oxide. These results should be further validated.

LEVEL OF EVIDENCE

3. Retrospective cohort study.

[A long distance between home and hospital does not bother ambulatory surgery for ureteroscopy in French Guyana]

INTRODUCTION

French Guyana is 83,500 km² wide (equivalent to 1/6 of France). Communes are distant. Public urology is set in Kourou only. These particularities led to develop ambulatory urological surgery including for patients living far away from the reference centre. We report our experience with patient ureteroscopy (URS).

MATERIAL

The study is retrospective (2018-2019), and includes 125 patients. Among these patients, 19.2% live in Kourou, 71.1% live 40 to 100km from the hospital and 9.7% beyond 100km. Every patient had an outpatient procedure for rigid and/or flexible URS to treat stone disease, including in lower calyx [LC] (38.4%). Ambulatory surgery was also proposed to the patients living away with the usual restrictions. Complications, results and switch to conventional hospitalisation (CH) were studied.

RESULTS

Mean stone size was 10,5mm (4-30), stone density was 1030 UH (470-1700). The postoperative complication rate was 4%. There were 90.4% 'stone free' patients (85.4% for LC). One patient was rehospitalised within 48hours for acute flank pain and 9 patients had a switch of ambulatory to CH: 6 for discharge too late and 3 for complication (fever and/or pain). Distance between home and hospital was linked neither to complication rate, nor to switch to CH.

CONCLUSION

Ambulatory URS is possible without further complications in selected patients living beyond 100km from the hospital, because of a specific organisation and an appropriate training of the caregivers involved in postoperative patient care.

LEVEL OF PROOF

3.