Catalin Pricop, Liviu Todosi, Dragos Puia, Oleg Mereuta, Catalin Ciuta, Martha Orsolya, George Daniel Radavoi.
Infected hydronephrosis: can we reduce patient suffering and costs?.
J Pak Med Assoc Jun ;66(11):1372-7.

Objective: To investigate the correlation among clinical parameters, risk factors, outcomes and costs in the context of patients with infected hydronephrosis. Methods: This retrospective, multi-centric study was conducted in three Romanian academic urology departments, and comprised data of patients with infected hydronephrosis treated between July 2013 and July 2014. Based on per-patient hospitalisation costs, the participants were divided into three groups: group A: cost less than 500 euros), group B: between 500 and 1,000 euros, and group C: over 1,000 euros). Differences between clinical parameters, comorbidities, type of procedure, admission to intensive care unit, length of hospital stay and costs were analysed. Results: Of the 175 patients, 49(28%) were in group A, 95(54.3%) in group B and 31(17.7%) in group C. The relevant parameters influencing outcomes and costs were age (p=0.001), neoplasical aetiology (p=0.001), leukocytosis (p=0.001), renal insufficiency (p=0.001), and moment of the intervention (p=0.005). Diabetes did not influence the costs (p=0.36). JJ stent insertion was tolerated at least the same as percutaneous nephrostomy, and with the same efficiency. Conclusion: In order to avoid patient suffering and to reduce costs linked to the treatment of infected hydronephrosis, the patient-general practitioner-specialist collaboration is of the utmost importance. Symptoms, signs, paraclinical features and empirical use of antibiotics may all lead to a delay in proper management, thus making the hospitalisation longer and the costs significantly higher.

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