Infection post ureteroscopy for ureteric stones: Hospital episode statistics analysis of 71305 cases

To investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) data warehouse.A retrospective cohort was identified and followed up in HES during the period April 2013-March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS ('index ureteroscopy') for each patient were further analysed. All subsequent admissions within 30 days were also captured. Primary outcome was diagnosis of urinary tract infection (including all codes relating to a urinary tract infection/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at accident and emergency department (A&E) within 30 days, and mortality.71,305 index ureteroscopies were eligible for analysis. The median age was 55 years, 81% of procedures were elective, 45% undertaken as day-case. 16% of patients had diabetes, 0.5% had co-existing neurological disease and 40% had an existing stent/nephrostomy at the time of index URS. Overall, 6.8% of the cohort (n= 4822) had a diagnosis of urinary tract infection within 30 days of index URS (3.9% immediately following surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in-hospital, 65 within 30 days); 40 deaths(0.056%) included infection as a contributing cause of death.We present the largest series evaluating infectious complications post ureteroscopic stone treatment. The procedure is safe with a low inpatient infective complication and critical care admission rate.