To describe variation in utilization and costs of inpatient care for patients with kidney stones, examining associations with older age.
Using the Nationwide Inpatient Sample we examined inpatient discharges with stone diagnoses from 2007-11. We examined length of stay, hospitalization cost, and post-discharge care utilization using multivariable regression to identify associations between patient/hospital characteristics and resource.
An estimated 1.7 million hospital discharges for stone disease occurred during the study period. Median length of stay was 2.1 days with a median cost of $6300. Hospital use was substantially higher among persons ≥65 years old (older adults) as compared to those aged 18-64 (younger adults): median length of stay was 3.1 days, with 25% staying more than 5.9 days. Older adults were significantly more likely to utilize home health (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 post-discharge 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).
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 post-discharge care. These findings suggest that efforts to understand and mitigate the impact of kidney stones on this vulnerable population are required.
Urology. 2018 Jun 22 [Epub ahead of print]
Eugene B Cone, Bradley G Hammill, Jonathan C Routh, Michael E Lipkin, Glenn M Preminger, Kenneth E Schmader, Charles D Scales
Duke Clinical Research Institute ; Duke University Medical Center - Department of Surgery, Division of Urology. Electronic address: ., Duke Clinical Research Institute ; Duke University Medical Center - Department of Medicine., Duke University Medical Center - Department of Surgery, Division of Urology; Duke University Medical Center - Department of Pediatrics., Duke University Medical Center - Department of Surgery, Division of Urology., Duke University Medical Center - Department of Medicine; Duke University School of Medicine; Durham VA Medical Center - Geriatric Research Education and Clinical Center., Duke Clinical Research Institute ; Duke University Medical Center - Department of Surgery, Division of Urology.