The rising burden of acute urologic disease at an urban, academic hospital network

Abstract

Introduction: Urologic presentations to the emergency department (ED) can represent a significant burden of disease. We aimed to evaluate trends in the incidence, management, and followup of urologic presentations to the ED at an urban, academic, tertiary-care hospital network over a 10-year period. Methods: A retrospective cohort study was conducted to include all patients presenting with renal colic (RC), gross hematuria (GH), or acute urinary retention (AUR) to EDs in the University Health Network in 2008–2009 and 2018–2019. Patient demographics and outcomes were compared between these two periods and between urologic presentations. Multilevel regression analyses identified predictors of in-patient admission, return to the ED, and clinic wait time. Results: A total of 2751 patients and 3510 ED visits were included (991 visits from 2008–09 and 2519 visits from 2018–19). Over time, increases were observed in all three presentations, largely driven by an almost five-fold increase in RC presentations. Multilevel regression analyses showed that older patients were more likely to be admitted from the ED, while age, 2018–19 era, and residence within the “downtown core” independently predicted return to the ED within 30 days of initial visit. Time to be seen in urology clinic increased over time for the entire cohort, and 14.4% of clinic visits were preceded by multiple ED visits. Conclusions: The incidence of acute urologic presentations increased significantly over a 10-year period at a tertiary-care hospital network. These findings demonstrate an increasing burden of acute urologic disease that is outpacing population growth and straining available resources.