University of Calgary
Outcomes of surgical vs. medical management in emergency departments for acute ureteral colic
Grant Innes1, Kevin Carlson1, James Andruchow1, Alec Mitchell1, Andrew McRae1, Eric Grafstein2, Frank Scheuermeyer2, Michael Law2, Joel Teichman2, Bryce A. Weber1.
1University of Calgary, Calgary, AB, Canada; 2University of British Columbia, Vancouver, BC, Canada
Introduction: Ureteric colic is a common condition that causes severe pain and generates substantial health system utilization.1-5 Management includes analgesia and a trial of spontaneous passage, which succeeds in most cases,5-9 but causes severe morbidity.10-14 Stone removal rapidly improves patient outcomes by relieving obstruction and pain,15-17 but to date, there has not been a study comparing early intervention with spontaneous passage.22
Methods: We looked at two health regions, Calgary Health Region and Vancouver Coastal Health region. Using regional administrative databases, we identified all emergency department (ED) patients with a diagnosis of renal colic. Eligible patients required computed tomography (CT) to confirm a stone 2.0–9.9 mm in size. Two cohorts were studied: an early intervention group, which had surgical intervention within three days from ED presentation, and a trial of spontaneous passage group, which did not receive surgical intervention for at least five days.
Results: We studied 3081 ED patients. Of these, 1168 (37.9%) underwent early surgical intervention and 1913 (62.0%) had a trial of spontaneous passage. Patients that underwent spontaneous passage saw adverse outcomes increase in a linear fashion, with increasing stone width and proximal location. In early intervention patients, outcomes are relatively constant regardless of stone size, but worse with proximal location.
Conclusions: This study provides strong evidence for specific stone parameters to guide early intervention in patients presenting with ureteral colic. This data suggests that patients having low-risk stones (width <5 mm) undergo a trial of spontaneous passage, that patients having high-risk stones (width >7.0 mm or proximal-middle >5 mm) be offered early surgical intervention, and that those with medium-risk stones (distal >5.0 mm) be managed on a case-by-case basis. These recommendations are more aggressive than current American guidelines, which recommend a trial of spontaneous passage at <10 mm.
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|Posters 3: Endourology||Outcomes of surgical vs medical management in emergency departments for acute ureteral colic||QCCC - 205 AB|