New York: Study on Decompression Delay and Mortality Risk

A delay in decompression increases mortality risk (by 29%) in patients with urinary tract infection and obstructing upper urinary tract stones, finds a recent study published in the Journal of Urology. Otherwise, the overall mortality risk is fairly low in such patients.

Obstructive pyelonephritis is a urological emergency that usually requires prompt treatment aimed at saving kidney viability. However, there is limited evidence on the importance of prompt decompression. Therefore, Ojas Shah, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, and colleagues sought to investigate whether delay in decompression is an independent predictor of in-hospital mortality. They also aimed to determine the impact of patient, hospital, and disease factors on the likelihood of receipt of delayed vs prompt decompression.

The researchers identified all patients 18 years old or older with ICD-9 diagnosis of urinary tract infection who had either a ureteral stone or kidney stone with hydronephrosis (311,100) using the National Inpatient Sample from 2010 to 2015. Two weighted sample multivariable logistic regression models assessed predictors of the primary outcome of death in the hospital and secondly, predictors of delayed decompression (2 or more days after admission).

Key Findings of the Study

• After controlling for patient demographics, comorbidity, and disease severity, delayed decompression significantly increased odds of death by 29% (OR 1.29).
• Delayed decompression was more likely to occur with weekend admissions (OR 1.22), nonwhite race (OR 1.34), and lower income demographic (lowest income quartile OR 1.25).

Although the findings highlight the truly life-saving nature of timely decompression, hospital systems must also seek to understand the barriers limiting the timely delivery of care.

"The increased likelihood of delay associated with weekend admissions, minority patients, and lower socioeconomic status suggests opportunities for improvement," concluded the authors.

The study, "Delayed Decompression of Obstructing Stones with Urinary Tract Infection is Associated with Increased Odds of Death," is published in the Journal of Urology.

DOI: https://www.auajournals.org/doi/10.1097/JU.0000000000001182