Factors influencing length of stay and suitability for early community discharge in the management of acute pyelonephritis

Author:

Hsu RCJ1,Shergill P1,Gnanapragasam VJ1

Affiliation:

1. Surgical Academic Urology Group, Department of Surgery, University of Cambridge, UK

Abstract

Objectives: We assessed factors influencing length of stay and suitability for early discharge to community care in acute pyelonephritis (APN). Methods: APN patients admitted in 2011–2012 to a tertiary hospital were included in a retrospective study. Data collected included patient demographics, Charlson Comorbidity Index (CCI), admitting speciality, imaging, length of stay and any intervention. Results: A total of 266 patients were analysed with 83.1% managed by urologists and the rest by other specialties. Urology patients had a shorter mean stay of 4.7 days compared to 8.8 days for non-urology patients ( p < 0.001). The mean time to imaging was 0.5 days and 1.4 days for urology and other specialties, respectively ( p < 0.001). Twenty per cent of patients had urinary tract abnormalities on imaging but only 2.0% required intervention; 9.4% (25/266) had repeated imaging following an initial scan but none resulted in an intervention. A high CCI was a predictor of longer stays regardless of admitting speciality ( p < 0.001). Admission to non-urological specialities remained a significant predictor both of delayed imaging ( p = 0.001) and longer stays ( p < 0.001) even after correction for CCI. Conclusion: Time to imaging, comorbidity and admitting speciality are key factors influencing APN management. Rapid urological review and imaging could identify patients suitable for safe early discharge to community management.

Publisher

SAGE Publications

Subject

Urology,Surgery

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