title: Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi.
abstract: OBJECTIVE
  The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention.
  
  
  METHODS
  Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression.
  
  
  RESULTS
  Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9-3.7).
  
  
  CONCLUSIONS
  Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.
authors.affiliation: Department of Urology, Nephrology Division and Section on Value and Effectiveness, New York University Langone Medical Center, New York University, New York, New York 10016, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Borofsky
authors.forename: Dawn
authors.initials: D
authors.lastname: Walter
authors.forename: Ojas
authors.initials: O
authors.lastname: Shah
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
authors.forename: Adam C
authors.initials: AC
authors.lastname: Mues
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
mesh_terms: D000368:Aged; D015897:Comorbidity; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality* / Q000601:surgery; D015607:Stents; D014481:United States / Q000453:epidemiology; D014514:Ureteral Calculi / Q000453:epidemiology* / Q000601:surgery