Presented by: Amit Shemesh MD
Samson Assuta Ashdod University Hospital

Introduction

The growing incidence of urolithiasis is reflected in a significant financial burden with increasing direct and indirect costs. The aim of this study is to evaluate the direct health care expenditure of ureteral stone management in Emergency Department (ED) patients in relation to their age and gender.

Materials

A retrospective analysis was conducted on all patients admitted to the ED and found to have a ureteric stone on CT. Clinical, laboratory, and imaging parameters were collected, along with data regarding admissions, ED readmissions, surgical procedures, and the total cost of treatment. The different cost rates were compared with regard to different stone parameters and characteristics, patient clinical presentation, laboratory results, and demographics.

Results

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Between January 2018 and January 2020, an abdominal CT-proven ureteric stone was found in 805 patients during an ED visit in a single institution. Of those, 773 patients met the inclusion criteria. Seventy-eight percent (609) were males, and 22% (169) were females, with a mean age of 50 years. Treatment costs were inversely related to age, costing $4,025, $5,116, $6,058, and $9,225 in the 18-30, 31-50, 51-70, and older than 70 age groups, respectively (p<0.001). Older age was related to unfavorable stone features and poorer presentation characteristics, with a larger stone size (p<0.001) and rate of proximal location (p=0.024), as well as higher creatinine level (p<0.001), higher inflammatory marker levels (CRP: p<0.001, WBC: p=0.0015), positive urine culture (PUC) (p<0.001), and fever (>37.8°C) (p=0.029). Older patients had a high rate of surgical procedures (p<0.001), a higher hospital admission rate (p=0.018), and a longer length of hospital stay (p=0.026). Female gender was associated with increased treatment costs, averaging at $6,831 compared to $5,450 in males (p=0.03). There were no differences between the genders in stone features (size p=0.18, proximal location p=0.13), the type of surgical procedure (p=0.5), or in hospital stay (p=0.1). However, female patients underwent more surgical procedures (p=0.016). The female population had predominantly higher rates of infection and increased inflammatory markers (PUC: p<0.001, fever: p=0.032, CRP: p=0.001).

Conclusion

Treatment costs were significantly affected by age and gender.  Older age and female gender were both found to be associated with increased direct treatment costs in the management of ureteric stones.

Funding

None

Co-Authors

Dor Golomb, MD
Samson Assuta Ashdod University Hospital

Hanan Goldberg, MD, MSc
SUNY Upstate Medical University

Eyal Hen, MD
Samson Assuta Ashdod University Hospital

Fahed Atamna, MD
Samson Assuta Ashdod University Hospital

Amir Cooper, MD
Samson Assuta Ashdod University Hospital

Orit Raz, MD
Samson Assuta Ashdod University Hospital