MP16-15 DISPARITIES IN INPATIENT CARE AND OUTCOMES FOR OLDER ADULTS WITH INFECTED STONES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP16-15 DISPARITIES IN INPATIENT CARE AND OUTCOMES FOR OLDER ADULTS WITH INFECTED STONES Alexandria Spellman, Tetsu Ohnuma, Sonali Advani, Vijay Krishnamoorthy, Karthik Raghunathan, Kenneth Schmader, Michael Lipkin, Jodi Antonelli, and Charles D. Scales Alexandria SpellmanAlexandria Spellman More articles by this author , Tetsu OhnumaTetsu Ohnuma More articles by this author , Sonali AdvaniSonali Advani More articles by this author , Vijay KrishnamoorthyVijay Krishnamoorthy More articles by this author , Karthik RaghunathanKarthik Raghunathan More articles by this author , Kenneth SchmaderKenneth Schmader More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Charles D. ScalesCharles D. Scales More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An obstructing urinary tract stone complicated by infection (septic stone) requires urgent intervention with both antibiotics and urinary tract decompression. Delayed treatment can lead to significant morbidity and sometimes mortality. Current published claims analyses reflect data up to 2011. Given a rapidly aging population and advances in critical care, we sought to examine characteristics and outcomes of patients with sepsis secondary to obstructing stones in a contemporary cohort, with a focus on outcomes in older adults. METHODS: We conducted a retrospective cohort study using data from the nationwide Premier Healthcare claims database (2016-2020) to identify hospital inpatients aged 18-95 treated for septic urolithiasis, using ICD-10 diagnostic codes consistent with sepsis with urinary stones. Baseline sociodemographic factors were described and stratified into 2 age groups: adults 65 years and older defined as “older adults”, and adults aged <65 years defined as the “younger cohort”. Outcomes such as length of stay, mortality, and discharge disposition were also compared in the 2 groups. RESULTS: The study cohort included 27,976 patients, of which 15,304 (54.7%) were older adults (Table 1). The average age of older adults was 76.0 (SD ±11.6) years, compared with 49.8 (SD ±7.3) years in younger cohort (p<0.001). Among older adults, 46.4% were male, versus 35.9% in the younger cohort; overall the cohort was predominantly non-Hispanic white (76.6%). Older adults were less likely to be cared for in teaching hospitals (p<0.001), and more likely to be cared for in smaller hospitals (<500 beds, p<0.001). Despite receiving more aggressive care (invasive mechanical ventilation, vasopressor use) and incurring higher costs (p<0.001), older adults experienced substantially higher mortality (RR 2.35, 95% confidence interval 2.1-2.7, p<0.001). In addition, older adults were significantly more likely to be discharged to a skilled nursing facility (31.8%) than younger adults (13.4%). CONCLUSIONS: Older adults hospitalized with septic stones have significantly worse outcomes, receive more aggressive care, and incur higher healthcare costs. Additional investigation is needed to identify patient, clinician, and facility-level drivers of these outcomes, so as to create pathways to reduce disparities and optimize outcomes for older adults. Source of Funding: Duke University © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e208 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandria Spellman More articles by this author Tetsu Ohnuma More articles by this author Sonali Advani More articles by this author Vijay Krishnamoorthy More articles by this author Karthik Raghunathan More articles by this author Kenneth Schmader More articles by this author Michael Lipkin More articles by this author Jodi Antonelli More articles by this author Charles D. Scales More articles by this author Expand All Advertisement PDF downloadLoading ...