IMPORTANCE Hyperglycemic crises (ie, diabetic ketoacidosis [DKA] and hyperglycemic hyperosmolar state [HHS]) are life-threatening acute complications of diabetes. Efforts to prevent these events at the population level have been hindered by scarce granular data and difficulty in identifying individuals at highest risk.
Background
Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is associated with patient morbidity and increased healthcare costs. To this effect, AUA guidelines recommend at least a urinalysis in patients prior to URS. We examined risk factors for infection-related hospitalization following URS for urinary stones in a surgical collaborative.
Methods
Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement (QI) initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) consisting of academic and community practices in the State of Michigan. Trained abstractors prospectively record standardized data elements from the health record in a web-based registry including patient characteristics, surgical details and complications. Using the ROCKS registry, we identified all patients undergoing primary URS for urinary stones between June 2016 and October 2017, and determined the proportion hospitalized within 30 days with an infection-related complication. These patients underwent chart review to obtain clinical data related to the hospitalization. Multivariable logistic regression analysis was performed to determine risk factors for hospitalization.
Results
1817 URS procedures from 11 practices were analyzed. 43 (2.4%) patients were hospitalized with an infection-related complication, and the mortality rate was 0.2%. Median time to admission and length of stay was 4 and 3 days, respectively. Nine (20.9%) patients did not have a pre-procedure urinalysis or urine culture, which was not different in the non-hospitalized cohort (20.5%). In hospitalized patients, pathogens included gram-negative (61.5%), gram-positive (19.2%), yeast (15.4%), and mixed (3.8%) organisms. Significant factors associated with infection-related hospitalization included higher Charlson comorbidity index, history of recurrent UTI, stone size, intra-operative complication, and procedures where fragments were left in-situ.
Conclusions
One in 40 patients are hospitalized with an infection-related complication following URS. Awareness of risk factors may allow for individualized counselling and management to reduce these events. Approximately 20% of patients did not have a pre-operative urine analysis or culture, and these findings demonstrate the need for further study to improve urine testing and compliance
Controlling hyperglycemia is foundational to diabetes management and is necessary to reduce the risks of long-term diabetes complications and death (1). However, people with diabetes also need to consider more immediate harms posed by dysglycemia. Contemporary data on emergency department (ED) visits and hospitalizations for hypoglycemia and hyperglycemia in the general U.S. population of adults with type 1 and type 2 diabetes, particularly in the context of the coronavirus disease 2019 (COVID-19) pandemic, are scarce.We used claims data of privately insured and Medicare Advantage beneficiaries across the U.S. included in the OptumLabs Data Warehouse between 1 January 2011 and 31 December 2020 to characterize annual trends in hypoglycemia-and hyperglycemia-related ED visits/hospitalizations (ascertained as previously described [2,3] and reported as the number of events per 1,000 person-years [1,000PY]) adjusted for patient age, sex, race, ethnicity, and U.S. region, with specific attention paid to 2020 as the first year of the COVID-19 pandemic. All study data are deidentified, and the study was exempt from Mayo Clinic Institutional Review Board review.
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