Research News

Comorbid UTIs Prolong Length of Stay and Hospital Charges in Patients with Congenital Obstructive Uropathy

Children with congenital obstructive uropathy (COU) who develop a urinary tract infection (UTI) during hospitalization face significant increases in length of stay and hospital charges.  These are the findings from a Nationwide Children’s Hospital study, the first to evaluate comorbid UTIs in a nationwide cohort of pediatric admissions for COU.  

The National Institute of Diabetes and Digestive and Kidney Diseases recently sought to establish the economic burden of urologic disease in the United States.  While the project evaluated pediatric UTIs and certain COU separately, no data were reported regarding comorbid UTIs in patients with COU.  
“It’s broadly accepted that recurrent UTIs can lead to renal scarring and hasten the progression to end-stage renal disease in patients with chronic kidney disease,” said Nationwide Children’s Nephrology Fellow Brian Becknell, MD, and study author.  “However, the impact UTIs have on inpatient healthcare utilization in patients with COU has not been examined.” 
To evaluate the impact of comorbid UTI on inpatient charges and length of stay for COU in the United State, Nationwide Children’s investigators examined data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database gathered in 2003 and 2006. The study sample consisted of 2,832 discharges at 357 different hospitals. 
They found that patients with COU and a secondary diagnosis of UTI had higher mean charges/hospitalization and length of stay when compared to general pediatric admissions with a primary diagnosis of UTI.  Comorbid UTIs increased mean charges by $7,910 and prolonged mean length of stay by 2.7 days.  Comorbid UTIs complicated nearly 7 percent of COU discharges and were most common in patients with posterior urethral valves.  
Dr. Becknell says the nature of the study prohibits determining why a secondary diagnosis of UTI prolongs length of stay for children with COU, but suggests that the reasons are many and complex. 
“Our findings emphasize the need for prevention, early detection and treatment of UTIs in this patient population,” said Dr. Becknell.  “Along with the increased health risks that UTIs can cause in COU patients they also result in a loss of family income from time away from work, disrupt patient education and/or employment and impact society at large by lengthening hospitalizations and increasing healthcare costs.” 
Becknell B, Hains DS, Schwaderer AL, Vanderbrink BA, Spencer JD, Reagan PB, McHugh KM. Impact of urinary tract infection on inpatient healthcare for congenital obstructive uropathy. J Pediatr Urol. 2011 Nov 23. [Epub ahead of print] 

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