Locke Jennifer A, Matta Rano, Saskin Refik, Nguyen Francis, Neu Sarah, Herschorn Sender
University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Division of Urology, University of Utah School of Medicine, Salt Lake City, Utah.
Urol Pract. 2021 Nov;8(6):636-644. doi: 10.1097/UPJ.0000000000000253. Epub 2021 Aug 23.
Iatrogenic ureteral injuries (IUIs) are rare but can lead to significant consequences if unrecognized at the time of injury. We compare the impact of immediate vs delayed recognition of IUIs on clinical, cost and health care utilization outcomes.
We conducted a population-based retrospective cohort study on patients who had a diagnosis of an IUI between 2003 and 2018. The primary independent variable was the time of diagnosis of IUI. The primary clinical outcomes evaluated included renal impairment and a composite outcome: hydronephrosis or stricture. Secondary outcomes included total direct health care costs and health care utilization.
We identified 1,193 patients who experienced an IUI, 25.2% of whom had a delay in recognition. Delayed recognition of IUI was associated with hydronephrosis or stricture within 1 year following treatment of IUI (OR 2.27, 95% CI 1.69-3.04, p <0.0001) and renal impairment within 2 years following treatment of IUI (OR 2.69, 95% CI 1.84-3.94, p <0.0001) compared to immediate diagnosis. Total health care costs (incident rate ratio [IRR] 2.06, 95% CI 1.89-2.24, p <0.0001), emergency department visits (IRR 2.07, 95% CI 1.77-2.43, p <0.0001), hospitalizations (IRR 1.62, 95% CI 1.48-1.78, p <0.0001) and outpatient urology visits (IRR 1.45, 95% CI 1.31-1.60, p <0.0001) were significantly higher in those with delayed recognition compared to immediate. Previous radiation was significantly associated with delayed recognition of IUI (OR 0.64, 95% CI 0.42-0.97, p=0.04).
Delayed recognition of IUI is associated with significant clinical, cost and health care utilization consequences.
医源性输尿管损伤（IUI）较为罕见，但如果在损伤时未被识别，可能会导致严重后果。我们比较了IUI即时识别与延迟识别对临床、成本和医疗保健利用结果的影响。
我们对2003年至2018年间诊断为IUI的患者进行了一项基于人群的回顾性队列研究。主要自变量是IUI的诊断时间。评估的主要临床结果包括肾功能损害和一个复合结果：肾积水或狭窄。次要结果包括直接医疗总成本和医疗保健利用情况。
我们确定了1193例经历IUI的患者，其中25.2%的患者诊断延迟。与即时诊断相比，IUI诊断延迟与IUI治疗后1年内的肾积水或狭窄（比值比[OR]2.27，95%置信区间[CI]1.69 - 3.04，p < 0.0001）以及IUI治疗后2年内的肾功能损害（OR 2.69，95% CI 1.84 - 3.94，p < 0.0001）相关。与即时诊断相比，诊断延迟患者的总医疗保健成本（发病率比值[IRR]2.06，95% CI 1.89 - 2.24，p < 0.0001）、急诊科就诊次数（IRR 2.07，95% CI 1.77 - 2.43，p < 0.0001）、住院次数（IRR 1.62，95% CI 1.48 - 1.78，p < 0.0001）和门诊泌尿外科就诊次数（IRR 1.45，95% CI 1.31 - 1.60，p < 0.0001）显著更高。既往接受过放疗与IUI诊断延迟显著相关（OR 0.64，95% CI 0.42 - 0.97，p = 0.04）。
IUI诊断延迟与显著的临床、成本和医疗保健利用后果相关。
