Psychiatric Diagnoses and Other Factors Associated with Emergency Department Return within 30 Days of Ureteroscopy

Abstract

PurposeEmergency department(ED) visits after ureteroscopy(URS) are costly and inconvenient. To better understand those at risk, we aim to identify patient demographic, medical and surgical factors associated with 30-day ED presentation following URS for urolithiasis with particular attention paid to those with a history of a psychiatric diagnosis(PD). Materials and MethodsWe retrospectively reviewed 1576 cases on 1395 adults who underwent stone-related URS over 3 years at two hospitals. We collected patient demographics, medical history, and operative details. The primary outcome was return to ED within 30 days of ureteroscopy. Logistic regression was performed to examine factors associated with ED presentation. Results613(43.9%) patients had a history of PD. 12.6% of URS encounters returned to the ED within 30 days of their ureteroscopy procedure. Of those, 58.8% had a history of PD. On multivariable analysis, variables associated with ED return included: history of PD(OR 1.57,p=0.012), uninsured status(OR 2.46,p=0.001), and stone only in the kidney(OR 1.76,p=0.022). Patients who returned to the ED had more ED visits in the year prior to surgery(OR 1.40,p<0.001). On univariable analysis, older patients and those with longer OR times were more frequently admitted from the ED(OR 1.03,p=0.002; OR 1.96,p=0.03 respectively) while uninsured patients were admitted less frequently(OR 0.19,p=0.013). No difference in admissions between those with a PD and all others(60.7% vs 55.8%;p=0.48). ConclusionsWe identified factors associated with ED return after ureteroscopy, including history of PD, uninsured status, and ED visits in the year before surgery. These patients may benefit from targeted interventions to help avoid unnecessary ED visits.