Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi

Michael S. Borofsky, Dawn Walter, Ojas Shah, David S. Goldfarb, Adam C. Mues, Danil V. Makarov

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Purpose: The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention. Materials and Methods: Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression. Results: Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9-3.7). Conclusions: Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.

Original languageEnglish (US)
Pages (from-to)946-951
Number of pages6
JournalJournal of Urology
Issue number3
StatePublished - Mar 2013

Bibliographical note

Funding Information:
We obtained data on 2007 to 2009 from the NIS. 9 The NIS is assembled through the AHRQ (Agency for Healthcare Research and Quality) sponsored HCUP (Healthcare Cost and Utilization Project). It is the largest all payer database in the United States and contains inpatient data on an approximately 20% sample of American community hospitals. It currently includes 1,050 hospitals in a total of 44 states, comprising approximately 8 million inpatient stays per year. It is the only national hospital database containing all payer cost information. Additional data on health care provider information was obtained from the 2009 to 2010 ARF. 10 The ARF is a national, county level database containing more than 6,000 variables on health facilities, professionals and resources. We performed preliminary analyses of the associations between data elements in the ARF and survival, which was our dependent variable of interest.


  • decompression
  • nephrolithiasis
  • sepsis
  • ureter
  • ureteral calculi


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