Impact of early surgical intervention on 1-year outcomes in patients hospitalized for macroscopic hematuria: a retrospective cohort study.
To evaluate the impact of early surgical intervention on outcomes in patients admitted non-electively for macroscopic hematuria, a clinical scenario with limited prior research.
We conducted a single-center, retrospective observational study including 261 consecutive patients admitted non-electively with a primary diagnosis of macroscopic hematuria to the Urology Department at Hospital Universitario 12 de Octubre, Spain, between January 2016 and June 2021. Patients were stratified into three groups: no surgical intervention, surgical intervention within 5 days, and surgical intervention after 5 days. Baseline characteristics, 365-day readmissions, and mortality were analyzed using binary logistic regression, zero-inflated Poisson, and Cox proportional hazards models.
The median age was 82 years and the median Charlson Comorbidity Index was 6. Crude 365-day readmission and mortality rates were 50.6% and 30.7%, respectively. Patients who underwent surgical intervention had lower 365-day mortality (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.32-0.97, p = 0.038) and readmission rates (odds ratio [OR] 0.28, 95% CI 0.15-0.54, p < 0.001). Significant risk factors for 365-day mortality included red blood cell transfusion (HR 2.12, 95% CI 1.29-3.49, p = 0.003), higher Charlson Comorbidity Index (HR 9.16, 95% CI 2.22-37.54, p = 0.002), and greater disease complexity (HR 2.35, 95% CI 1.63-3.39, p < 0.001). The single-center, retrospective design limits the generalizability of these findings.
In this cohort of elderly patients with substantial comorbidity, early surgical intervention, when clinically indicated, was associated with significantly reduced 365-day mortality and readmission rates.
We conducted a single-center, retrospective observational study including 261 consecutive patients admitted non-electively with a primary diagnosis of macroscopic hematuria to the Urology Department at Hospital Universitario 12 de Octubre, Spain, between January 2016 and June 2021. Patients were stratified into three groups: no surgical intervention, surgical intervention within 5 days, and surgical intervention after 5 days. Baseline characteristics, 365-day readmissions, and mortality were analyzed using binary logistic regression, zero-inflated Poisson, and Cox proportional hazards models.
The median age was 82 years and the median Charlson Comorbidity Index was 6. Crude 365-day readmission and mortality rates were 50.6% and 30.7%, respectively. Patients who underwent surgical intervention had lower 365-day mortality (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.32-0.97, p = 0.038) and readmission rates (odds ratio [OR] 0.28, 95% CI 0.15-0.54, p < 0.001). Significant risk factors for 365-day mortality included red blood cell transfusion (HR 2.12, 95% CI 1.29-3.49, p = 0.003), higher Charlson Comorbidity Index (HR 9.16, 95% CI 2.22-37.54, p = 0.002), and greater disease complexity (HR 2.35, 95% CI 1.63-3.39, p < 0.001). The single-center, retrospective design limits the generalizability of these findings.
In this cohort of elderly patients with substantial comorbidity, early surgical intervention, when clinically indicated, was associated with significantly reduced 365-day mortality and readmission rates.
Authors
Calzas Montalvo Calzas Montalvo, Martín Arranz Martín Arranz, Bernal Sobrino Bernal Sobrino, Juste Álvarez Juste Álvarez, Quirós González Quirós González, García Barrio García Barrio, Caro González Caro González, Miranda Utrera Miranda Utrera, Gil Moradillo Gil Moradillo, Rodríguez Antolín Rodríguez Antolín, Tejido Sánchez Tejido Sánchez
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