Veeratterapillay Rajan, Gravestock Paul, Harding Chris, Shaw Matthew, Fitzpatrick John, Keltie Kim, Cognigni Paola, Sims Andrew, Rogers Alistair
The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Faculty of Medical Sciences, Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
BJU Int. 2023 Jan;131(1):109-115. doi: 10.1111/bju.15850. Epub 2022 Aug 12.
To investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) data warehouse.
A retrospective cohort was identified and followed up in HES during the period April 2013 to March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS ('index ureteroscopy') for each patient were further analysed. All subsequent admissions within 30 days were also captured. The primary outcome was diagnosis of urinary tract infection (UTI; including all codes relating to a UTI/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at the accident and emergency department (A&E) within 30 days, and mortality.
A total of 71 305 index ureteroscopies were eligible for analysis. The median age was 55 years, and 81% of procedures were elective and 45% were undertaken as day-cases. At the time of index URS, 16% of patients had diabetes, 0.5% had coexisting neurological disease and 40% had an existing stent/nephrostomy. Overall, 6.8% of the cohort (n = 4822) had a diagnosis of UTI within 30 days of index URS (3.9% immediately after surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in-hospital, 65 within 30 days); 40 deaths (0.056%) included infection as a contributing cause of death.
We present the largest series evaluating infectious complications after ureteroscopic stone treatment. The procedure is safe, with low inpatient infective complication and critical care admission rates.
利用医院事件统计（HES）数据仓库的数据，在英国全国范围内调查输尿管镜检查（URS）治疗输尿管结石后感染性并发症的负担。
确定一个回顾性队列，并在2013年4月至2020年3月期间在HES中对所有与输尿管镜结石治疗相关的手术编码（M27.1、M27.2、M27.3）进行随访。对每位患者首次URS（“索引输尿管镜检查”）相关的治疗事件进行进一步分析。还记录了30天内所有后续入院情况。主要结局是尿路感染（UTI；包括索引URS后30天内所有与UTI/脓毒症相关的编码）的诊断。次要结局是重症监护就诊、30天内到急诊部（A&E）就诊以及死亡率。
共有71305例索引输尿管镜检查符合分析条件。中位年龄为55岁，81%的手术为择期手术，45%为日间手术。在索引URS时，16%的患者患有糖尿病，0.5%患有并存神经系统疾病，40%已有支架/肾造瘘。总体而言，该队列中有6.8%（n = 4822）在索引URS后30天内被诊断为UTI（术后立即为3.9%）。共有339例患者（0.5%）在索引URS住院期间需要意外入住重症监护病房；8833例患者（12%）在30天内到A&E就诊。总体死亡率为0.18%（住院期间60例，30天内65例）；40例死亡（0.056%）包括感染作为死亡的一个促成原因。
我们展示了评估输尿管镜结石治疗后感染性并发症的最大系列研究。该手术是安全的，住院感染性并发症和重症监护病房入住率较低。
