(1400) Identifying ICU Admission Risk Factors Following Emergent Cystoscopy for Obstructive Stone Disease

Introduction: Emergency surgery creates inherent institutional burdens including the need for personnel, OR space, and potential postoperative admission. At our institution, urologic interventions are commonly booked as emergent add-on cases. This study aims to analyze patterns in intensive care unit (ICU) admissions following emergent cystoscopy for obstructive urolithiasis and identify factors associated with postoperative ICU admission.

Methods: Adults who underwent emergent cystoscopy and stenting for management of radiographically confirmed obstructive urolithiasis at our tertiary care center from 10/2017-10/2023 were retrospectively examined. Demographic data, vital signs, and laboratory data were extracted using Epic reporting. Patients were stratified based on admission to the ICU postoperatively and analyzed using linear regression models.

Results: 314 patients met inclusion criteria and 134 (42.6%) were admitted to the ICU postoperatively. Among those requiring ICU admission, older age at presentation, prior history of urolithiasis, septic by SIRS criteria, creatinine >1.2 mg/dL, normal urine leukocyte esterase (LE), and lactate >2 mmol/L were statistically significant predictive variables. Subgroup analysis of only ICU-admitted patients stratified by prior history of urolithiasis revealed for no variables of statistical significance. In the overall analysis, variables such as sex, history of diabetes, time of day for emergency surgery booking, positive urine bacteria, positive urine nitrite, and urine WBC count > 2/hpf were not predictive of ICU admission.

Conclusions: The necessity and optimal timing of decompression for cases of acute ureteral obstruction remain ill-defined, resulting in varying clinical practice patterns. We identified that increased respiratory rate, heart rate, temperature, abnormal WBC count, elevated creatinine, abnormal lactate, normal LE, and prior history of urolithiasis were predictors for requiring ICU care. This underscores the complexities of managing acute patients and allocating limited hospital resources. Future work could validate these findings in the context of improved patient outcomes in resource-challenged environments and evaluate clinical decision making surrounding the booking of emergent and nonemergent cases.