MP-21 Impact of Delayed Recognition of Iatrogenic Ureteric Injury in a Retrospective Population-Based Study
01/01/70 from 21:45 to 22:15
Award Winner
Jennifer A. Locke, Canada has been granted the

Jennifer A. Locke, Canada



Sunnybrook Health Sciences Centre, University of Toronto


Impact of delayed recognition of Iatrogenic ureteric Injury in a retrospective population-based study

Jennifer A. Locke1, Rano Matta2, Refik Saskin3, Francis Nguyen3, Sarah Neu1, Sender Herschorn1.

1Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2Urology, University of Utah School of Medicine, Salt Lake City, UT, United States; 3ICES, Toronto, ON, Canada

This study was supported by ICES, which is funded by an annual grant from the Ontario MOH.

Introduction: Latrogenic ureteric injuries (IUI) are rare but can lead to significant consequence if unrecognized at the time of injury.  In this population-based study, we compare the impact of immediate versus delayed recognition of IUI on patient, cost and health care system outcomes.

Methods: We conducted a population-based, retrospective-cohort study on patients who had a diagnosis of an IUI between 2003-2018.  The primary independent variable was the time of diagnosis of IUI.  The primary outcomes were hydronephrosis or ureteric stricture (composite outcome), and renal impairment. We also evaluated each primary outcome separately. Secondary outcomes included total direct healthcare costs and patient healthcare utilization. 

Results: We identified 1,193 patients who experienced an IUI, 25.2% of whom had a delayed recognition (diagnosis of IUI >= 1 day after the index surgery date).  Late delayed recognition of IUI (>=14 days after the index surgery) was associated with hydronephrosis or stricture in 1 year following treatment of IUI (OR 2.48, 95% CI:1.77-3.46, p<0.0001) and renal impairment in 2 years following treatment of IUI (OR 3.20, 95% CI:2.11-4.88, p<0.0001) as compared to immediate diagnosis.  Patients who had late delayed recognition of IUI incurred health care costs three times that of the immediate diagnosis group (RR 2.26, 95% CI:2.05-2.49, p<0.00001). They also had twice the mean number of ED visits (IRR 2.46, 95% CI:2.06-2.93, p<0.0001), hospitalizations (IRR 1.89, 95% CI:1.71-2.09, p<0.0001) and outpatient urology visits (IRR=1.67, 95% CI:1.50-1.86, p<0.0001) as compared to the immediate recognition group.  

Conclusions: In this population-based study, delayed recognition of IUI was associated with increased rates of adverse clinical outcomes, increased healthcare costs and healthcare utilization.  These findings underscore the importance of identifying IUIs at the time of injury.




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