Affiliation:
1. Division of Urology Centre Hospitalier de l'Université de Montréal Montréal QC Canada
2. Harvard Medical School Massachusetts General Hospital Boston MA USA
3. University of California San Diego School of Medicine San Diego CA USA
4. Health Economics and Market Access Boston Scientific Marlborough MA USA
5. Department of Urologic Sciences University of British Columbia Vancouver BC Canada
Abstract
ObjectiveTo determine 30‐day inpatient mortality, intensive care unit (ICU) admissions, inpatient admissions/readmissions, and yearly trends in sepsis prevalence and inpatient mortality after ureteroscopy (URS) in employed adults.Materials and MethodsWe performed a retrospective analysis of the IBM MarketScan Commercial Database to identify employed adults aged 18–64 years who underwent URS between 2015 and 2019. Patients were categorized as having no sepsis (controls), non‐severe sepsis, or severe sepsis within 30 days of URS. The main outcomes included inpatient mortality, ICU admissions, inpatient admissions, readmissions, and annual rates of sepsis and associated inpatient mortality.ResultsAmong 109 496 patients undergoing URS, 5.6% developed sepsis (4.1% non‐severe, 1.5% severe). The 30‐day inpatient mortality rates were 0.03%, 0.3% and 2.5% for controls, non‐severe sepsis and severe sepsis, respectively (P < 0.001). In a multivariable analysis, diagnosis of sepsis regardless of severity (hazard ratio [HR] 17.2, 95% confidence interval [CI] 10.5–28.1; P < 0.001) or severe sepsis (HR 49.5, 95% CI 28.9–84.7; P < 0.001) increased the risk of 30‐day inpatient mortality compared to no sepsis (controls). ICU admissions on the day of procedure (1.5%, 19.8% and 52.4%), inpatient admission rates (18.3%, 74.9% and 76.9%) and readmission rates (7.1%, 12.0% and 15.9%) were higher with severe sepsis and non‐severe sepsis vs controls (all P < 0.001). During the study period, the prevalence of sepsis after URS increased from 4.7% to 6.6% (P < 0.001), while the associated mortality rate decreased from 0.7% to 0.2% (P < 0.001).ConclusionAmong working adults aged 18–64 years, sepsis after URS increases the risk of 30‐day inpatient mortality, ICU and hospital admission, and hospital readmission. Although the prevalence of sepsis after URS is increasing over time, associated mortality rates are declining. Urologists should be aware of the potentially deadly consequences of sepsis after URS in younger patients.
Funder
Boston Scientific Corporation
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