title: Trends in surgery for upper urinary tract calculi in the USA using the Nationwide Inpatient Sample: 1999-2009.
abstract: OBJECTIVE
  To determine trends in demographics and treatment for inpatient upper urinary tract calculi in the USA using a population-based cohort.
  
  
  METHODS
  All patients with a primary or secondary diagnosis of kidney or ureteric calculus between 1999 and 2009 in the US Nationwide Inpatient Sample were extracted and weighted. Temporal trend analyses were used to determine trends in gender, race and age presentation, as well as utilization rates of interventions. Temporal trends were quantified using the estimated annual percent change (EAPC) using least squares linear regression analysis.
  
  
  RESULTS
  Overall, 2 109 455 patients were hospitalized with upper urinary tract calculi over the 11-year period. The majority of admissions were for ureteric calculi (63.4%). Admissions for renal calculus increased by 12.1% during the study period (EAPC + 0.92%, P = 0.039, 95% CI: 0.17-1.66), whilst discharges for ureteric calculus remained stable. A significant increase (25.4%) in hospitalizations for women was found (EAPC + 2.21%, P < 0.001, 95% CI: 1.40-3.03); by 2006, more women than men were admitted to hospital (95 953 vs. 94 556, respectively). There were significant increases in hospitalization for black, Hispanic and older patients. Significant changes in the use of all studied interventions were found except for ureteroscopy, extracorporeal shockwave lithotripsy and nephrectomy.
  
  
  CONCLUSIONS
  In this nationally representative sample of inpatient discharges, significant increases were found in admissions for renal compared with ureteric calculi, and for black, Hispanic and older patients. With regard to surgical intervention, the largest increase was found in the use of procedures for kidney calculi. Women now comprise the majority in the inpatient management of stone disease.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA. krghani@gmail.com
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007297:Inpatients; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States; D014514:Ureteral Calculi / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000639:trends; D055815:Young Adult