The rising burden of acute urologicall disease at an urban, academic hospital network
Simon Czajkowski1, Katherine Lajkosz1, Alex Koziarz2, David Carr3, Antonio Finelli1,4, Jason Y. Lee1,4.
1Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada; 2Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 3Emergency Medicine, University of Toronto, Toronto, ON, Canada; 4Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
Introduction: Urological presentations to the emergency department (ED) constitute a significant burden of disease. We aimed to evaluate trends in the incidence, management, and followup of patients presenting to an urban, academic, tertiary care hospital with renal colic (RC), acute urinary retention (AUR), and gross hematuria (GH) over a 10-year period.
Methods: A retrospective cohort study was conducted to include all patients presenting with RC, AUR, or GH to University Health Network EDs over two different time periods: 2008–09 and 2018–19. Multilevel regression models were used to evaluate differences between the two time periods for the following outcomes: patient demographics, incident ED visits based on presenting diagnosis, return visits to the ED, and time to urology clinic followup.
Results: A total of 3510 ED visits were included, of which 991 were from 2008–09 and 2519 were from 2018–19 (Table 1). Mean age decreased from 62.6 to 60.1 years in 2018–19, with more females in the 2018–19 cohort (19.5 vs. 24%). There was an increase in RC presentations (248 vs. 1138 visits in 2018–19), AUR presentations (373 vs. 679), and GH presentations (370 vs. 702). In 2018–19, 7.9% of ED visits occurred within 30 days of surgery, 10.1% of all patients were admitted as in-patients from the ED (6.7% for RC, 6.3% for AUR, and 19.5% for GH), and 31.8% of patients returned to the ED within 30 days of initial ED presentation. Multilevel regression analyses showed that older patients (odds ratio [OR] 1.07, p=0.02), patients living in the downtown core (OR 1.34, p=0.001), and 2018–19 ED patients (OR 1.23, p=0.039) were more likely to return to the ED within 30 days. Time to be seen in urology clinic post-ED visit increased significantly over time for the entire cohort (mean 21.1 vs. 29.8 days, p<0.001) and 14.4% of all patients had multiple ED visits prior to being seen in urology clinic (9% vs. 17% in 2018–9, p<0.001).
Conclusions: The incidence of acute urological presentations increased significantly over a 10-year period at a tertiary care hospital. These findings demonstrate an increasing burden of acute urological disease that is outpacing population growth and currently available healthcare resources.
