MP17-07 COSTS AND OUTCOMES ASSOCIATED WITH THE MANAGEMENT OF PATIENTS ACUTELY PRESENTING WITH NONNEUROGENIC URINARY RETENTION

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-07 COSTS AND OUTCOMES ASSOCIATED WITH THE MANAGEMENT OF PATIENTS ACUTELY PRESENTING WITH NONNEUROGENIC URINARY RETENTION David Friedlander, Davis Viprakasit, and Matthew Nielsen David FriedlanderDavid Friedlander More articles by this author , Davis ViprakasitDavis Viprakasit More articles by this author , and Matthew NielsenMatthew Nielsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is a common and costly clinical condition effecting men worldwide. The most severe sequela of progressive BPH is nonneurogenic acute urinary retention (AUR), affecting 33% of men >80 years of age. Little is known about non-clinical factors that influence rates of BPH progression and overall clinical outcomes following an episode of AUR. We sought to identify clinical and non-clinical predictors of post-AUR patterns of care and associated costs. METHODS: All-payer data from the 2016 Healthcare Cost and Utilization Project State Databases from Florida and New York were used to identify 30,827 men ≥40 years of age acutely presenting with AUR and track subsequent acute care encounters over a 1-year period. Patient demographics, regional data, and procedural information were collected, and episode-based costs were calculated. Multivariable logistic and gamma generalized linear regression were utilized to identify predictors of acute care revisit/subsequent bladder outlet procedure and episode-based costs, respectively. RESULTS: Of the 30,827 patients presenting with AUR, 5,409 (7.5%) experienced at least one additional hospital revisit for AUR, whereas 1,987 (6.4%) subsequently underwent a bladder outlet procedure. Older age (≥80 vs. <70: OR 1.31, 95% CI 1.20-1.42; p <0.001), Medicare vs. private insurance (OR 1.16, 95% CI 1.05-1.29; p=0.005), Black vs. White race (OR 1.18, 95% CI 1.07-1.30; p=0.001), and higher education level (OR 1.13, 95% CI 1.01-1.26; p=0.03) were all associated with increased odds of hospital revisit for recurrent AUR. Regarding subsequent bladder outlet procedure, increasing number of revisits (OR 4.39, 95% CI 3.94-4.89; p <0.001), age (≥80 vs. <70: OR 0.53, 95% CI 0.44-0.63; p <0.001), comorbidity status (CCI ≥3 vs. 0: OR 0.31, 95% CI 0.26-0.36; p <0.001), and insurance type (Medicaid vs. private: OR 0.52, 95% CI 0.36-0.73; p <0.001) all influenced odds of subsequent surgery. Mean unadjusted costs associated with an outlet procedure and revisit were $6,245.58 and $15,675.90, respectively. Mean episode-based costs were higher among individuals who did not undergo a subsequent bladder outlet procedure ($16,223.38, 95% CI $15,423.61-$17,023.15 vs. $17,690.54, 95% CI $17,402.93-$17,978.15; p=0.04). CONCLUSIONS: AUR is a common and costly sequela of BPH, and both clinical and non-clinical factors influence the frequency and type of follow-up care received by patients with AUR. Surgical intervention following AUR may be protective against costly revisits resulting from recurrent AUR. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e310-e310 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Friedlander More articles by this author Davis Viprakasit More articles by this author Matthew Nielsen More articles by this author Expand All Advertisement Loading ...