Disproportionate Use of Inpatient Care by Older Adults With Kidney Stones - 19/09/18

Doi : 10.1016/j.urology.2018.06.007

Eugene B. Cone ^a,^b,^⁎ , Bradley G. Hammill ^a,^d, Jonathan C. Routh ^b,^c, Michael E. Lipkin ^b, Glenn M. Preminger ^b, Kenneth E. Schmader ^d,^e,^f, Charles D. Scales ^a,^b
^a Duke Clinical Research Institute, Durham, NC
^b Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC
^c Duke University Medical Center, Department of Pediatrics, Durham, NC
^d Duke University Medical Center, Department of Medicine, Durham, NC
^e Duke University School of Medicine, Durham, NC
^f Durham VA Medical Center, Geriatric Research Education and Clinical Center, Durham, NC

^⁎Address correspondence to: Eugene B. Cone, M.D., Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715.Duke Clinical Research InstituteP.O. Box 17969DurhamNC27715

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 19 September 2018

Abstract

Objective

To describe variation in utilization and costs of inpatient care for patients with kidney stones, examining associations with older age.

Materials and Methods

Using the Nationwide Inpatient Sample we examined inpatient discharges with stone diagnoses from 2007 to 2011. We examined length of stay, hospitalization cost, and postdischarge care utilization using multivariable regression to identify associations between patient/hospital characteristics and resource.

Results

An estimated 1.7million hospital discharges for stone disease occurred during the study period. Median length of stay was 2.1days with a median cost of $6300. Hospital use was substantially higher among persons ≥65years old (older adults) as compared to those aged 18-64 (younger adults): median length of stay was 3.1days, with 25% staying more than 5.9days. Older adults were significantly more likely to utilize home health (odds ratio [OR] 3.6) or skilled nursing (OR 5.0) after discharge. Older adults accounted for 1 in 3 hospital discharges, 40% of costs, and half of postdischarge care utilization. They were more likely to be septic during hospitalization (OR 1.8) which doubled costs per episode, but less likely to receive surgery (OR 0.93).

Conclusion

While historically at lower risk for kidney stones compared to younger adults, older adults utilizing inpatient care account for a disproportionate share of the economic burden of disease. Utilization is higher for older adults across multiple dimensions, including hospital costs, length of stay, and postdischarge care. These findings suggest that efforts to understand and mitigate the impact of kidney stones on this vulnerable population are required.

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Plan

Financial Disclosure: Dr. Preminger is a consultant for Retrophin, Boston Scientific. The remaining authors declare that they have no relevant financial interests.

Funding/Support: Dr. Scales was supported by the NIA GEMSSTAR R03AG048130 grant. Dr. Schmader is supported by by the Duke Pepper Center NIA P30AG028716. Dr. Routh is supported by K08-DK100534 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The views expressed in this article are those of the authors and do not necessarily reflect the position and policy of the United States Federal Government or the Department of Veterans Affairs. No official endorsement should be inferred.
The funding sources had no role in the collection, analysis or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.