Division of Urology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA; Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA.
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA.
J Pediatr Urol. 2018 Feb;14(1):13.e1-13.e6. doi: 10.1016/j.jpurol.2017.09.001. Epub 2017 Sep 7.
The incidence of urolithiasis in the pediatric population in the United States has steadily been increasing over the past few decades. Few studies to date have examined trends in the hospitalization and inpatient surgical treatment of urolithiasis in the pediatric population using nationally representative data.
The aim was to evaluate nationwide trends in the rates of pediatric hospitalization and inpatient surgical activity for upper urinary tract calculi (UUTC) in the United States from 2001 to 2014.
The National Inpatient Sample (NIS) databases for 2001-2014 were queried. Hospitalizations for patients younger than age 18 (excluding newborns), with principal discharge diagnoses of kidney or ureteral calculi were selected. Surgical procedures during hospitalization were identified. Hospitalization and surgical activity data were analyzed using trends tests, chi-square statistics, and multivariable logistic regression as appropriate.
Of an estimated 30.2 million pediatric hospitalizations during the study period, 44,369 overall (147 per 100,000) were for UUTC. The total number and proportion of UUTC hospitalizations per 100,000 all-cause admissions significantly decreased between 2001 and 2014 (p < 0.0001) (figure). Surgical intervention was undertaken in 19,946 (45%) of UUTC hospitalizations, with significantly increasing frequency over the study interval (p < 0.0001). Urinary tract drainage was the most frequently performed surgical intervention. On multivariable analysis, significant predictors of a higher likelihood of undergoing inpatient surgical intervention during hospitalization for UUTC included older age, female gender, deficiency anemias, hypertension, neurologic disorders, paralysis, and hospitalization after 2001.
The declining trend in hospitalization for UUTC likely reflects a shift toward outpatient care for routine cases, reserving hospitalization for sicker patients or those with complications of urolithiasis. Similar to previous studies, we also observed that girls were significantly more likely than boys to be hospitalized for stone disease, and that majority of the stone activity in the pediatric population was in children aged 15-17 years. We also observed a sharp increase in the proportion of hospitalized patients who underwent surgical intervention between 2001 and 2014, but the primary driver of this trend remains uncertain.
Pediatric hospitalizations for UUTC in US children significantly decreased between 2001 and 2014, while of those hospitalized the proportion who underwent stone-related surgical intervention significantly increased over the same period. A shift towards outpatient care, reserving hospitalization and inpatient surgical care for sicker patients, those with urolithiasis-related complications, or those who fail conservative management, is a possible explanation for these observed trends.
在美国，过去几十年来，儿科人群中尿路结石的发病率一直在稳步上升。迄今为止，很少有研究使用全国代表性数据来检查儿科人群尿路结石（UUTC）住院和住院手术治疗的趋势。
本研究旨在评估 2001 年至 2014 年美国儿童上尿路结石（UUTC）住院率和住院手术活动的全国趋势。
查询了 2001-2014 年国家住院患者样本（NIS）数据库。选择了年龄小于 18 岁（不包括新生儿）、主要出院诊断为肾或输尿管结石的患者住院治疗。识别住院期间的手术程序。使用趋势检验、卡方检验和多变量逻辑回归分析住院和手术活动数据。
在研究期间，估计有 3020 万例儿科住院治疗，其中 44369 例（每 10 万人中有 147 例）为 UUTC。每 100000 例所有病因住院治疗的 UUTC 住院治疗总数和比例在 2001 年至 2014 年间显著下降（p < 0.0001）（图）。在 UUTC 住院治疗中，有 19946 例（45%）接受了手术干预，在研究期间频率显著增加（p < 0.0001）。尿路引流是最常进行的手术干预。多变量分析显示，UUTC 住院期间接受住院手术干预的可能性更高的显著预测因素包括年龄较大、女性、营养性贫血、高血压、神经障碍、瘫痪以及 2001 年后住院。
UUTC 住院率的下降趋势可能反映了常规病例向门诊护理的转变，为病情较重的患者或结石病并发症患者保留住院治疗。与之前的研究类似，我们还观察到女孩因结石疾病住院的可能性明显高于男孩，且儿科人群中大多数结石活动发生在 15-17 岁的儿童中。我们还观察到，2001 年至 2014 年间，接受手术干预的住院患者比例急剧增加，但这一趋势的主要驱动因素仍不确定。
美国儿童 UUTC 的儿科住院治疗在 2001 年至 2014 年间显著减少，而在此期间住院接受结石相关手术治疗的比例显著增加。将护理转向门诊，为病情较重的患者、有结石病相关并发症的患者或经保守治疗无效的患者保留住院和住院手术治疗，可能是这些观察到的趋势的解释。
