Mp50-10 psychiatric diagnoses and other factors associated with emergency department return within 30 days of ureteroscopy

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2018MP50-10 PSYCHIATRIC DIAGNOSES AND OTHER FACTORS ASSOCIATED WITH EMERGENCY DEPARTMENT RETURN WITHIN 30 DAYS OF URETEROSCOPY Evan Carlos, Chloe Peters, Brenton Winship, Daniel Wollin, Leah Gerber, Jingqiu Li, Zachary Dionise, Charles Scales, Glenn Preminger, and Michael Lipkin Evan CarlosEvan Carlos More articles by this author , Chloe PetersChloe Peters More articles by this author , Brenton WinshipBrenton Winship More articles by this author , Daniel WollinDaniel Wollin More articles by this author , Leah GerberLeah Gerber More articles by this author , Jingqiu LiJingqiu Li More articles by this author , Zachary DioniseZachary Dionise More articles by this author , Charles ScalesCharles Scales More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Michael LipkinMichael Lipkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1621AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Up to 16% of ureteroscopy (URS) cases return to the emergency department (ED) within 30 days. Studies in general and spine surgery have identified those with psychiatric diagnoses (PD) as more likely to utilize the ED in the acute postoperative period. We aim to identify factors associated with ED presentation within 30 days of URS with particular attention paid to PD. METHODS We retrospectively reviewed 323 adults who underwent diagnostic or stone-related URS from Jan-Dec 2016. We collected patient demographics, PDs at the time of URS, stone characteristics, and operative details. The primary outcome was return to ED within 30 days of URS. Univariable and multivariable logistic regression was performed to assess factors associated with return to the ED. RESULTS The median age of the 323 patients was 59 years. 39 (12%) patients returned to the ED within 30 days and 18 (46%) of them were admitted during that encounter. Among all 323, one or more PD was found in 135 (42%) patients and 23 of the 39 (59%) who returned to the ED. There was no difference in same-encounter admission rate from the ED between those with a PD and all others (p=1.0). Of the 135 with a PD, 89 (66%) had anxiety, 96 (71%) had depression and 57 (42%) had both. Those with a PD had more preoperative (pre-op) ED visits in the year prior to URS (median 0 vs 1, p<0.001).The following were independently associated with 30 day ED return: one or more PD at the time of URS, increasing number of pre-op ED visits, African American (AfA) race, Medicaid and no insurance statuses (all p<0.025). A multivariate regression showed the following to be associated with 30 day ED return: one or more PD at the time of URS (OR=2.21, p=0.047), increasing number of pre-op ED visits (OR=1.42, p=0.001), AfA race (OR=3.82, p=0.008), and having a stent with no string (OR=4.78, p=0.044). A stone <7mm (OR=0.23, p=0.017) posed a decreased risk. A subpopulation multivariable analysis of those with a PD showed an increasing number of pre-op ED visits (OR=1.36, p=0.005) to be associated with return to the ED within 30 days. CONCLUSIONS In our series, one or more PD at the time of URS, pre-op ED visits, AfA race, and having a stent without a string were associated with 30 day ED return after URS. A stone <7mm decreased this risk. We had a large proportion of patients with PD who used the ED more both pre- and post-op with no difference in same-encounter hospital admission. Additional educational and follow up resources could be directed toward this at-risk population to avoid unnecessary ED visits. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e679 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Evan Carlos More articles by this author Chloe Peters More articles by this author Brenton Winship More articles by this author Daniel Wollin More articles by this author Leah Gerber More articles by this author Jingqiu Li More articles by this author Zachary Dionise More articles by this author Charles Scales More articles by this author Glenn Preminger More articles by this author Michael Lipkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...