- Email: [email protected]
E55 Factors affecting hospital readmission and re-hospitalization after percutaneous nephrolithotomy
50
THURSDAY 10 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78
differences between the novice and the experts were not significant in the present study. Moreover, the majority of the complications in PCNLs performed by the novice were minor and did not compromise patient safety. E55 Factors affecting hospital readmission and re-hospitalization after percutaneous nephrolithotomy Tepeler A.1, Karatag T.2, Tok A.1, Ozyuvali E.3, Buldu I.2, Kardas S.1, Kucukdagli O.T.4, Unsal A.5 1Faculty of Medicine, Bezmialem Vakif University, Dept. of Urology, Istanbul, Turkey, 2Faculty of Medicine, Mevlana University, Dept. of Urology, Konya, Turkey, 3Kecioren Teaching and Research Hospital, Dept. of Urology, Ankara, Turkey, 4 Faculty of Medicine, Bezmialem Vakif University, Dept. of Emergency, Istanbul, Turkey, 5Faculty of Medicine, Gazi University, Dept. of Urology, Ankara, Turkey Introduction and objectives: To identify patient- and procedurerelated factors that increase the risk of hospital readmission (HR) and emergency room (ER) visits after percutaneous nephrolithotomy (PNL). Materials and methods: We retrospectively reviewed the records of patients with kidney stones treated via PNL in two tertiary referral hospitals between 2008 and 2014. Patient demographics including age, body mass indices (BMIs), ASA score, stone size, presence of anatomical abnormality and comorbidity, operative and postoperative measures, and ER visit and re-hospitalization rates were reviewed. Unplanned readmission to the hospital including elective, and ER visits due to any reason related to the PNL procedure were primarily examined. The factors affecting ER visit and rehospitalization rate were analysed using Logistic regression analysis. Results: A total of 1024 patients (mean age: 46.57 years) were enrolled into the study. Mean stone size was 28.5 mm. Stone free status was achieved in 81.7% of the procedures. Complications occurred at a rate of 6.44% in the postoperative period. ER visit and re-hospitalization rates were 5.76% and 5.27%, respectively. While stone complexity, anatomical abnormalities and postoperative course were found to be factors affecting ER visit, postoperative course and hospitalization time were main predictors for re-hospitalization rate. Conclusions: Our outcomes demonstrate that patients, who had an anatomic abnormality and complex kidney stone, were more likely to have an unplanned hospital readmission. Patients with a history of perioperative and/or postoperative complication seem to have a tendency to unplanned readmission and rehospitalization. 16.30–18.05 Sala 5 (1st floor) Poster session 5: Pathophysiology / Metaphylaxis / Metabolism / Stone analysis E56 Urinary stone composition analysis in a representative sample of the Portuguese population Baltazar P.M., Meirinha A., Patena-Forte J.P., Severo L.A., Campos-Pinheiro L. Hospital De São José, Dept. of Urology, Lisbon, Portugal Introduction and objectives: Urinary stone formation is a multifactorial process that includes genetic, environmental, and hormonal interactions; assessment of stone composition is a fundamental step in the metabolic evaluation of patients with stone disease. There is important information from such investigation that can direct metabolic evaluation and aid with
preventive therapy. Stone composition can also determine the recurrence risk status of stone formers. This retrospective descriptive study aimed to evaluate urinary stone composition analysis at our institution during a five years period of time and to highlight epidemiological characteristics of urinary stone composition in the Portuguese population. Materials and methods: We reviewed the stone analysis reports of all patients submitted to urinary stone treatment procedures over a five year period at our institution – Centro Hospitalar Lisbon Central (from January 2010 to January 2015). The identified patients were screened for age, gender, stone composition and number of substance mixture. Results: From a total 462 stone analysis reports, 24 were excluded for insufficient stone material for a valid analysis. From 438 valid reports, 59,6% (n = 261) were from male patients and 40,4% (n = 177) were from female patients; mean patient age was 52,0 (ranging from 17 to 94 years old); A total of 6 different mineral components were identified. 97,3% (n = 426) of all the stones had Calcium Oxalate, 34,2% (n = 150) had Magnesium Ammonium Phosphate (Struvite), 31,5% (n = 138) had Uric Acid, 13,7% (n = 60) had Ammonium Urate, 6,8% (n = 30) had Brushite and 4,1% (n = 18) had Apatite. Most of the stones had 2 (60,3%), 3 (10,9%) or 4 (2,7%) mineral components. Only 26,1% (n = 114) were chemically homogeneous; Calcium Oxalate, Calcium Phosphate (Apatite/ Brushite) and Ammonium Urate were equally distributed in both genders. Uric Acid stones (34,5% vs 23,7%) were more prevalent in male patients. In female patients, Magnesium Ammonium Phosphate stones (44,1% vs 22,9%) were more prevalent. Conclusions: In economically developed countries urinary stones typically occurs in adults and featuring mainly calcium oxalate and phosphate. Our analysis confirms this fact in our population. The prevalence of this type of stones varies on account of environmental factors, especially dietary intake and lifestyle, although they are less useful diagnostically as they occur in several pathological entities. Uric Acid and Struvite stones seems to have a different gender distribution what can suggest different prevalence of specific pathological conditions. This report gives a better understanding of the epidemiological characteristics of urinary stone composition of the Portuguese population, which can be used to plan therapeutic approaches, improve preventive measures of primary stone formation and decrease the recurrence rate. E57 Hyperoxaluria in women with recurrent pyelonephritis associated with the deficit of Lactobacillus spp. in the gut and vaginal microbiota Stepanova N., Kolesnyk M., Stashevska N. State Institution Institute of Nephrology of The National Academy of Medical Sciences, Dept. of Nephrology and Dialysis, Kyiv, Ukraine Introduction and objectives: Hyperoxaluria is considered as a major risk factor for the formation of calcium oxalate stone which constitute about 75% of all renal calculis. Nephrolithiasis and prenephrolithiasis states often coexist with recurrent pyelonephritis. Antibacterial treatment and long-term antibiotic prophylaxis can violate the normal flora of the gastrointestinal tract and reproductive system in the patients with recurrent pyelonephritis. The purpose of the present study was to investigate the state of the gut and vagina microbiota in the patients with recurrent pyelonephritis and their relations to hyperoxaluria. Materials and methods: This study represents the data of the microbiological stool examination and vaginal biocenosis in 64 women with recurrent pyelonephritis, non-stone formers. The mean age in the patient population was 21-48 years (31.6±7.7).
THURSDAY 10 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78
differences between the novice and the experts were not significant in the present study. Moreover, the majority of the complications in PCNLs performed by the novice were minor and did not compromise patient safety. E55 Factors affecting hospital readmission and re-hospitalization after percutaneous nephrolithotomy Tepeler A.1, Karatag T.2, Tok A.1, Ozyuvali E.3, Buldu I.2, Kardas S.1, Kucukdagli O.T.4, Unsal A.5 1Faculty of Medicine, Bezmialem Vakif University, Dept. of Urology, Istanbul, Turkey, 2Faculty of Medicine, Mevlana University, Dept. of Urology, Konya, Turkey, 3Kecioren Teaching and Research Hospital, Dept. of Urology, Ankara, Turkey, 4 Faculty of Medicine, Bezmialem Vakif University, Dept. of Emergency, Istanbul, Turkey, 5Faculty of Medicine, Gazi University, Dept. of Urology, Ankara, Turkey Introduction and objectives: To identify patient- and procedurerelated factors that increase the risk of hospital readmission (HR) and emergency room (ER) visits after percutaneous nephrolithotomy (PNL). Materials and methods: We retrospectively reviewed the records of patients with kidney stones treated via PNL in two tertiary referral hospitals between 2008 and 2014. Patient demographics including age, body mass indices (BMIs), ASA score, stone size, presence of anatomical abnormality and comorbidity, operative and postoperative measures, and ER visit and re-hospitalization rates were reviewed. Unplanned readmission to the hospital including elective, and ER visits due to any reason related to the PNL procedure were primarily examined. The factors affecting ER visit and rehospitalization rate were analysed using Logistic regression analysis. Results: A total of 1024 patients (mean age: 46.57 years) were enrolled into the study. Mean stone size was 28.5 mm. Stone free status was achieved in 81.7% of the procedures. Complications occurred at a rate of 6.44% in the postoperative period. ER visit and re-hospitalization rates were 5.76% and 5.27%, respectively. While stone complexity, anatomical abnormalities and postoperative course were found to be factors affecting ER visit, postoperative course and hospitalization time were main predictors for re-hospitalization rate. Conclusions: Our outcomes demonstrate that patients, who had an anatomic abnormality and complex kidney stone, were more likely to have an unplanned hospital readmission. Patients with a history of perioperative and/or postoperative complication seem to have a tendency to unplanned readmission and rehospitalization. 16.30–18.05 Sala 5 (1st floor) Poster session 5: Pathophysiology / Metaphylaxis / Metabolism / Stone analysis E56 Urinary stone composition analysis in a representative sample of the Portuguese population Baltazar P.M., Meirinha A., Patena-Forte J.P., Severo L.A., Campos-Pinheiro L. Hospital De São José, Dept. of Urology, Lisbon, Portugal Introduction and objectives: Urinary stone formation is a multifactorial process that includes genetic, environmental, and hormonal interactions; assessment of stone composition is a fundamental step in the metabolic evaluation of patients with stone disease. There is important information from such investigation that can direct metabolic evaluation and aid with
preventive therapy. Stone composition can also determine the recurrence risk status of stone formers. This retrospective descriptive study aimed to evaluate urinary stone composition analysis at our institution during a five years period of time and to highlight epidemiological characteristics of urinary stone composition in the Portuguese population. Materials and methods: We reviewed the stone analysis reports of all patients submitted to urinary stone treatment procedures over a five year period at our institution – Centro Hospitalar Lisbon Central (from January 2010 to January 2015). The identified patients were screened for age, gender, stone composition and number of substance mixture. Results: From a total 462 stone analysis reports, 24 were excluded for insufficient stone material for a valid analysis. From 438 valid reports, 59,6% (n = 261) were from male patients and 40,4% (n = 177) were from female patients; mean patient age was 52,0 (ranging from 17 to 94 years old); A total of 6 different mineral components were identified. 97,3% (n = 426) of all the stones had Calcium Oxalate, 34,2% (n = 150) had Magnesium Ammonium Phosphate (Struvite), 31,5% (n = 138) had Uric Acid, 13,7% (n = 60) had Ammonium Urate, 6,8% (n = 30) had Brushite and 4,1% (n = 18) had Apatite. Most of the stones had 2 (60,3%), 3 (10,9%) or 4 (2,7%) mineral components. Only 26,1% (n = 114) were chemically homogeneous; Calcium Oxalate, Calcium Phosphate (Apatite/ Brushite) and Ammonium Urate were equally distributed in both genders. Uric Acid stones (34,5% vs 23,7%) were more prevalent in male patients. In female patients, Magnesium Ammonium Phosphate stones (44,1% vs 22,9%) were more prevalent. Conclusions: In economically developed countries urinary stones typically occurs in adults and featuring mainly calcium oxalate and phosphate. Our analysis confirms this fact in our population. The prevalence of this type of stones varies on account of environmental factors, especially dietary intake and lifestyle, although they are less useful diagnostically as they occur in several pathological entities. Uric Acid and Struvite stones seems to have a different gender distribution what can suggest different prevalence of specific pathological conditions. This report gives a better understanding of the epidemiological characteristics of urinary stone composition of the Portuguese population, which can be used to plan therapeutic approaches, improve preventive measures of primary stone formation and decrease the recurrence rate. E57 Hyperoxaluria in women with recurrent pyelonephritis associated with the deficit of Lactobacillus spp. in the gut and vaginal microbiota Stepanova N., Kolesnyk M., Stashevska N. State Institution Institute of Nephrology of The National Academy of Medical Sciences, Dept. of Nephrology and Dialysis, Kyiv, Ukraine Introduction and objectives: Hyperoxaluria is considered as a major risk factor for the formation of calcium oxalate stone which constitute about 75% of all renal calculis. Nephrolithiasis and prenephrolithiasis states often coexist with recurrent pyelonephritis. Antibacterial treatment and long-term antibiotic prophylaxis can violate the normal flora of the gastrointestinal tract and reproductive system in the patients with recurrent pyelonephritis. The purpose of the present study was to investigate the state of the gut and vagina microbiota in the patients with recurrent pyelonephritis and their relations to hyperoxaluria. Materials and methods: This study represents the data of the microbiological stool examination and vaginal biocenosis in 64 women with recurrent pyelonephritis, non-stone formers. The mean age in the patient population was 21-48 years (31.6±7.7).