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Factors influencing length of stay and suitability for early community discharge in the management of acute pyelonephritis

Objectives: We assessed factors influencing length of stay and suitability for early discharge to community care in acute pyelonephritis (APN). Methods: APN patients admitted in 2011–2012 to a tertiary hospital were included in a retrospective study. Data collected included patient demographics, Charlson Comorbidity Index (CCI), admitting speciality, imaging, length of stay and any intervention. Results: A total of 266 patients were analysed with 83.1% managed by urologists and the rest by other specialties. Urology patients had a shorter mean stay of 4.7 days compared to 8.8 days for non-urology patients (p < 0.001). The mean time to imaging was 0.5 days and 1.4 days for urology and other specialties, respectively (p < 0.001). Twenty per cent of patients had urinary tract abnormalities on imaging but only 2.0% required intervention; 9.4% (25/266) had repeated imaging following an initial scan but none resulted in an intervention. A high CCI was a predictor of longer stays regardless of admitting speciality (p < 0.001). Admission to non-urological specialities remained a significant predictor both of delayed imaging (p = 0.001) and longer stays (p < 0.001) even after correction for CCI. Conclusion: Time to imaging, comorbidity and admitting speciality are key factors influencing APN management. Rapid urological review and imaging could identify patients suitable for safe early discharge to community management.