title: Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice.
abstract: Obstructing nephrolithiasis is a common condition that can require urgent intervention. In this study we analyze patient factors that contribute to delayed intervention during acute stone admission.
  
  
  
  We retrospectively reviewed the HCUP SID (Healthcare Cost and Utilization Project State Inpatient Database) for Florida and California from 2007 to 2011. Patients who were admitted urgently with nephrolithiasis and an indication for decompression (urinary tract infection, acute renal insufficiency and/or sepsis) were included in the study. Intervention was timely or delayed, defined as a procedure that occurred within or after 48 hours, respectively. Adjusted multivariate models were fit to assess factors that predicted a delayed procedure as well as mortality.
  
  
  
  Overall 10,301 patients were admitted urgently for nephrolithiasis with indications for decompression. Early intervention occurred in 6,689 patients (65%) and was associated with a decrease in mortality (11, 0.16%), compared to delayed intervention (17 of 3,612, 0.47%, p=0.002). On multivariate analysis timely intervention significantly decreased the odds of inpatient mortality (OR 0.43, p=0.044). Weekend day admission significantly influenced time to intervention, decreasing patient odds of timely intervention by 26% (p <0.001). Other factors decreasing patient odds of timely intervention included nonCaucasian race and nonprivate insurance. Presenting medical diagnoses of urinary tract infection, sepsis and acute renal failure did not appear to influence time to intervention.
  
  
  
  Delayed operative intervention for acute nephrolithiasis admissions with indications for decompression results in increased patient mortality. Nonmedical factors such as the "weekend effect," race and insurance provider exerted the greatest influence on the timing of intervention.
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois. Electronic address: rblackwell@lumc.edu.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Blackwell
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Barton
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Anai N
authors.initials: AN
authors.lastname: Kothari
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Matthew A C
authors.initials: MA
authors.lastname: Zapf
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Flanigan
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Gopal N
authors.initials: GN
authors.lastname: Gupta
mesh_terms: D000208:Acute Disease; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D002140:California; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D005431:Florida; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000401:mortality / Q000601:surgery*; D010343:Patient Admission; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data*
keywords: outcome assessment (health care); socioeconomic factors; urinary calculi; urologic surgical procedures