Abstract
Introduction
Nationwide data on urological hospitalizations may improve the quality of care. This study aimed to evaluate the epidemiological characteristics of all registered hospital admissions to adult urological departments in Poland in 2022.
Material and methods
This epidemiological retrospective analysis is based on the national registry on hospital admissions managed by the National Institute of Public Health – National Research Institute. All adult patients admitted to urological departments were included in the analysis.
Results
In 2022, 214,063 hospital admissions were recorded in Polish urological departments, 72% of the patients were male. Emergency admissions accounted for 17.6% of these admissions. There were significant differences in hospitalization rate per 100,000 population between the administrative regions (voivodeships), with extreme values recorded in the Opolskie (411.5) and Podkarpackie (987.9) voivodeships. The major causes of admission were genitourinary diseases (ICD-10: N00-N99) at 59% and cancers (ICD-10: C00-C97; D00-D48) at 36%. In general, kidney and ureteral stones (19.9%), bladder cancer (15.2%), and prostate hyperplasia (10%) were the most common causes of hospital admissions. The highest hospitalization rate per 100,000 inhabitants was observed among adults aged 60–69 and 70–79 years. A quarter of hospitalizations were one-day hospitalizations, and the mean duration of hospitalization was 2.93 days for all hospitalizations, and when excluding one-day hospitalizations 3.89 days. Epidemiological characteristics of patients and duration of hospitalization differed by cause of admission.
Conclusions
Findings from this study provide precise epidemiological data on inpatient urological care in Poland. Physicians and policymakers may use this study to evaluate and improve inpatient urological care in Poland.
Keywords: urology, hospitalization, Poland, urological care, nationwide data
INTRODUCTION
Urological diseases are a wide group of urinary tract diseases, pelvic conditions, and genital condi-tions [1–4]. The most prevalent urological diseases are urinary tract infections (UTIs), urolithiasis, bladder control problems, and prostate hyperplasia [1, 2, 4]. Moreover, urologists also treat oncological patients diagnosed with prostate cancer, bladder cancer, and kidney cancer [3].
Globally, over 150 million cases of community-acquired UTIs are reported annually [2]. Global prev-alence of urolithiasis ranges from 1% up to 13% [1]. Socioeconomic changes and changes in lifestyle habits led to a rise in urolithiasis incidence from 77.78 million incident cases in 1990 to 115.55 million in 2019 (an increase of 48.57%) [1]. Population aging and an increase in expected life expectancy led to an increase in the global prevalence of prostate hyperplasia, from 51.1 million cases in 2000 to 94 million cases in 2019 [4]. A significant rise in the global prevalence of urological cancers is observed globally. Between 1990 and 2019 the global incidence of kidney cancer increased by 155%, bladder cancer by 123%, and prostate cancer by 169% [5]. The growing global burden of urological diseases will lead to increased utilization of urological care [3–5]. Urological diseases are treated both in outpatient and inpatient settings. A significant part of urological care is related to surgical procedures both diagnostics (e.g., biopsy, cystoscopy, ureteroscopy) and treatment (e.g., lithotripsy, cancer resection) [6]. The organization of urological care differs across the countries.
In Poland, as of January 2024, there were 1,461 active urologists and 79 pediatric urologists [7]. Urological care is offered both by public and private institutions and funded under mandatory health insurance (public services within the insurance – National Health Fund) or private healthcare services (paid-for service) [8]. There are both public and private medical facilities offering inpatient urological care. Patients admitted to urological departments within the public funding system require a referral and are admitted according to position on the waiting list [9]. Waiting time differs between the med-ical facilities and departments [10]. A total of 881 urology clinics offered a medical consultation within the mandatory health insurance in January 2024 [10]. There are approximately 120 urological departments in Poland [10]. Urological departments are most often part of multi-profile public hospitals located in larger cities. Urological departments are also managed by private medical facilities, mostly as monoprofile hospitals [8, 11].
Patients with urological diseases are referred to urological departments mainly for diagnosis and treatment using surgical procedures (including minimally invasive surgery) [11, 12]. A significant part of urological hospital care is one day surgery admissions, mostly related to radiological tests (e.g., urography), ultrasound-guided prostate biopsy, non-surgical breaking of stones, as well as endoscopic examinations and procedures [13].
Data on patients admitted to urological departments are limited to single-center or multicenter studies, wherein there is a lack of nationwide data on urological inpatient care in Poland [14–16].
Therefore, this study aimed to evaluate the epidemiological characteristics of 214,063 hospital ad-missions to adult urological departments in Poland between January and December 2022.
MATERIAL AND METHODS
Data source and data collection methods
This epidemiological retrospective analysis is based on the nationwide registry on hospital admission managed by the National Institute of Public Health – National Research Institute [17]. Under the Polish law on nationwide statistics, all public and private hospitals (except the psychiatric units) are obligated to report data on hospitalized patients using a discharge report template. Data from discharge reports are collected and aggregated by the Nationwide General Hospital Morbidity Study Registry scientific board [17]. All medical facilities are trained on reporting procedures by the representatives of the National Institute of Public Health – National Research Institute. Discharge reports include demographic data (gender, age, place of residence), hospital characteristics, admission details (dates of admission, type of admission, cause of admission, hospital wards), comorbidities, and outcome of hospitalization (duration of hospitalization and its course). Data are coded with personal data protection rules and are anonymous. Data on medical conditions are based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) [18] and filled out by physicians.
Data were obtained from the National Institute of Public Health – National Research Institute based on the request for public information for scientific purposes.
Hospital admissions to urological departments
Data on all patients admitted to adult urological departments were included in this study. Hospital admissions to urological departments were identified using the medical codes for hospital departments and other hospital care units listed in the Ordinance of the Ministry of Health on May 17, 2012 [19]. Urological departments were identified using code “4640” as listed in the Ordinance of the Ministry of Health [19]. Data on patients (a total of 15,996 patients in 2022) who were transferred to the urology department from other departments (the urology department was not the first admission department) were not included in this study.
Causes of hospitalization (primary diagnosis) were defined by physicians in discharge reports using ICD-10 codes [18]. Patients hospitalized due to genitourinary diseases were identified using ICD-10 codes N00-N99. Patients hospitalized due to cancers were identified using ICD-10 codes C00-C97 and D00-D48 [18].
The following ICD-10 codes were used to identify patients with selected diseases: prostate cancer (C61), kidney cancer (C64), bladder cancer (C67), neoplasm of uncertain or unknown behavior of male genital organs (D40), neoplasm of uncertain or unknown behavior of urinary organs (D41), obstructive and reflux uropathy (N13), kidney and ureteral stones (N20), stones of lower urinary tract (N21), unspecified renal colic (N23), urethral stricture (N35), and hyperplasia of prostate (N40) [17].
The type of hospital admission was based on the discharge data and classified into two categories: emergency admission and scheduled admission.
If physicians filled out data on secondary diagnoses and coexisting diseases in discharge reports, patients were classified as those with comorbidities.
The comparable methodology was used in previously published retrospective epidemiological analyses based on the Nationwide General Hospital Morbidity Study Registry [20, 21].
Statistical analysis
The data were analyzed with IBM SPSS Statistics v.29 (USA: IBM, Armonk, NY). Epidemiological characteristics of patients admitted to urological departments were presented with descriptive statistics typical for registry-based studies. As the nationwide data were used, hospital admissions per 100,000 adult inhabitants were calculated based on the demographic data from Statistics of Poland (Statistical Yearbooks. Demographic Yearbook of Poland 2022) [22], including data on age, gender, and administrative region of residence. A separate analysis was conducted for the most common causes of admission to urological departments.
Bioethical standards
The Ethical Committee at the Medical University in Warsaw, Poland approved the study protocol, decision AKBE/338/2023 as of December 2023. The study was carried out following the Declaration of Helsinki regulations. Patient consent was waived as anonymous and retrospective data from public statistics (Nationwide General Hospital Morbidity Study Registry) were used.
RESULTS
Number of hospital admissions to urological departments in 2022
In 2022, a total of 214,063 hospital admissions to urological departments (for adults) were reported. Almost three-quarters of patients admitted to urological departments were males (Table 1). Emergency admissions accounted for 17.6% of admissions to urological departments in 2022. Monthly number of hospital admissions varied from 15,338 in January and 15,346 in February to 19,709 in March and 19,668 in May (Table 1).
Table 1.
Number of hospital admissions to urological departments per month, January-December 2022
| Month | Overall (n = 214,063) | Gender | Type of hospital admission | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Male (n = 155,349) | Female (n = 58,714) | Emergency (n = 37,669) | Scheduled (n = 176,394) | |||||||
| n | % | n | % | n | % | n | % | n | % | |
| January | 15,338 | 7.2 | 11,172 | 7.2 | 4,166 | 7.1 | 2,856 | 7.6 | 12,482 | 7.1 |
| February | 15,346 | 7.2 | 11,330 | 7.3 | 4,016 | 6.8 | 2,694 | 7.2 | 12,652 | 7.2 |
| March | 19,709 | 9.2 | 14,353 | 9.2 | 5,356 | 9.1 | 3,270 | 8.7 | 16,439 | 9.3 |
| April | 17,238 | 8.1 | 12,551 | 8.1 | 4,687 | 8.0 | 3,149 | 8.4 | 14,089 | 8.0 |
| May | 19,668 | 9.2 | 14,233 | 9.2 | 5,435 | 9.3 | 3,424 | 9.1 | 16,244 | 9.2 |
| June | 18,287 | 8.5 | 13,283 | 8.6 | 5,004 | 8.5 | 3,199 | 8.5 | 15,088 | 8.6 |
| July | 17,899 | 8.4 | 12,936 | 8.3 | 4,963 | 8.5 | 3,296 | 8.7 | 14,603 | 8.3 |
| August | 18,363 | 8.6 | 13,377 | 8.6 | 4,986 | 8.5 | 3,606 | 9.6 | 14,757 | 8.4 |
| September | 18,092 | 8.5 | 13,070 | 8.4 | 5,022 | 8.6 | 3,212 | 8.5 | 14,880 | 8.4 |
| October | 18,760 | 8.8 | 13,595 | 8.8 | 5,165 | 8.8 | 3,161 | 8.4 | 15,599 | 8.8 |
| November | 19,564 | 9.1 | 14,014 | 9.0 | 5,550 | 9.5 | 3,178 | 8.4 | 16,386 | 9.3 |
| December | 15,799 | 7.4 | 11,435 | 7.4 | 4,364 | 7.4 | 2,624 | 7.0 | 13,175 | 7.5 |
In 2022, there were 692.4 hospital admissions per 100,000 adult inhabitants in Poland. There were markable differences in the hospital admissions per 100,000 adult inhabitants by administrative regions (voivodeships). The number of hospital admissions per 100,000 adult inhabitants in Opolskie (411.5), Wielkopolskie (469.0), Małoposkie (471.4) and Zachodniopomorskie (475.1) Voivodeships was almost two times lower than in Kujawsko-pomorskie (829.6) and Podkarpackie (987.9) Voivodeships (Table 2). Over one-quarter of all hospital admissions to urological departments took place in Śląskie and Mazowieckie Voivodeships (Table 2).
Table 2.
Regional differences in the number of hospital admissions to urological departments in Poland in 2022
| Voivodeship | Number of hospital admissions | Hospital admissions per 100,000 adult inhabitants | Percentage of total admissions |
|---|---|---|---|
| Dolnośląskie | 13,574 | 530.1 | 6.3 |
| Kujawsko-pomorskie | 14,533 | 829.6 | 6.8 |
| Lubelskie | 13,972 | 788.8 | 6.5 |
| Lubuskie | 5,592 | 651.1 | 2.6 |
| Łódzkie | 17,258 | 817.0 | 8.1 |
| Małopolskie | 13,811 | 471.4 | 6.5 |
| Mazowieckie | 31,323 | 663.6 | 14.6 |
| Opolskie | 3,451 | 411.5 | 1.6 |
| Podkarpackie | 17,707 | 987.9 | 8.3 |
| Podlaskie | 5,708 | 575.3 | 2.7 |
| Pomorskie | 14,865 | 737.3 | 6.9 |
| Śląskie | 24,922 | 649.6 | 11.6 |
| Świętokrzyskie | 8,051 | 766.9 | 3.8 |
| Warmińsko-mazurskie | 8,335 | 701.0 | 3.9 |
| Wielkopolskie | 14,038 | 469.0 | 6.6 |
| Zachodniopomorskie | 6,923 | 475.1 | 3.2 |
| Total | 214,063 | 692.4 | 100.0 |
Age of the patients admitted to urological departments
Most of the patients (58.8%) admitted to urological departments were aged 60–79 years, wherein there were 39564 hospital admissions of patients aged 65–69 years and 38065 hospital admissions of patients aged 70–74 years (Figure 1).
Figure 1.
Number of patients admitted to urological departments by age group.
Epidemiological characteristics of patients admitted to urological departments
One-quarter of hospitalizations (24.6%) were one-day hospitalizations (<24 h). The mean duration of hospitalization was 2.93 ±3.62 days, median of 2 days. When excluding one-day hospitalizations, the mean duration of hospitalization was 3.89 ±3.69 days, a median of 2 days. Almost all of the patients (99.1%) were hospitalized in one ward (only the urological department, without transfer to other wards). A total of 716 (0.3%) in-hospital deaths were reported. Most of the patients were admitted to urological departments due to genitourinary diseases (59%) or cancers (36%), and 5% of patients were admitted due to other medical conditions (Table 3). Kidney and ureteral stones (19.9%) was the most common cause of admission to urological departments (Table 3). Out of all genitourinary cancers, bladder cancer (15.2%) was the most common cause of admission. One-tenth of hospital admissions were caused by hyperplasia of the prostate (Table 3). In general, diseases of male genital organs (N40-N51) accounted for 16.6% of all hospital admissions to urological departments According to the data available in the nationwide registry, physicians working in urological departments reported that only 16.7% of patients admitted to urological departments had comorbidities (Table 3).
Table 3.
Characteristics of patients admitted to urological departments in 2022
| Overall n = 214,063 | ||
|---|---|---|
| Variable | n | % |
| Gender | ||
| male | 155,349 | 72.6 |
| female | 58,714 | 27.4 |
| Age | ||
| 18–29 | 8,959 | 4.2 |
| 30–39 | 13,737 | 6.4 |
| 40–49 | 18,649 | 8.7 |
| 50–59 | 27,768 | 13.0 |
| 60–69 | 67,061 | 31.3 |
| 70–79 | 58,885 | 27.5 |
| 80–89 | 17,531 | 8.2 |
| 90+ | 1,473 | 0.7 |
| One-day hospitalization (<24 h) | ||
| yes | 52,573 | 24.6 |
| no | 161,490 | 75.4 |
| Duration of hospitalization (days) | 2.93 ±3.62 | |
| mean ±SD; median (min–max) | 2 (0–275) | |
| Duration of hospitalization when excluded one-day hospitalizations (days) (n = 161,490) | 3.89 ±3.69 | |
| mean ±SD; median (min–max) | 2 (1–275) | |
| Type of admission | ||
| emergency | 37,669 | 17.6 |
| scheduled | 176,394 | 82.4 |
| Number of hospital wards | ||
| 1 | 212,219 | 99.1 |
| 2 | 927 | 0.4 |
| 3 | 820 | 0.4 |
| 4 | 48 | 0.1 |
| 5 | 49 | 0.1 |
| Cause of admission | ||
| cancers (C00-C97; D00-D48) | 76,957 | 36.0 |
| prostate cancer (C61) | 13,123 | 6.1 |
| kidney cancer (C64) | 5,402 | 2.5 |
| bladder cancer (C67) | 32,553 | 15.2 |
| neoplasm of uncertain or unknown behaviour of male genital organs (D40) | 6,535 | 3.1 |
| neoplasm of uncertain or unknown behaviour of urinary organs (D41) | 15,207 | 7.1 |
| genitourinary diseases (N00-N99) | 126,270 | 59.0 |
| obstructive and reflux uropathy (N13) | 20,975 | 9.8 |
| kidney and ureteral stones (N20) | 42,504 | 19.9 |
| stones of lower urinary tract (N21) | 3,085 | 1.4 |
| unspecified renal colic (N23) | 1,058 | 0.5 |
| urethral stricture (N35) | 5,486 | 2.6 |
| hyperplasia of prostate (N40) | 21,382 | 10.0 |
| redundant prepuce, phimosis and paraphimosis (N47) | 5,287 | 2.5 |
| other causes | 10,836 | 5.0 |
| In-hospital death | ||
| yes | 716 | 0.3 |
| no | 213,347 | 99.7 |
| Data on comorbidities reported in the registry | ||
| yes | 35,780 | 16.7 |
| no | 178,283 | 83.3 |
Age-differences in the causes of hospital admissions to urological departments
The highest hospitalization rate per 100,000 inhabitants was observed among adults aged 70–79 years (1,925.8 per 100,000 inhabitants). The hospitalization rate per 100,000 inhabitants for all major causes of hospitalization doubled in a group aged 50–59 years (610.6) compared to a group aged 40–49 (317.8). Moreover, a markable increase in hospitalization rate per 100,000 inhabitants was observed between 50–59 and 60–69 years. Details are presented in Table 4.
Table 4.
Causes of hospital admission to urological department by age groups in Poland in 2022
| 18–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | 80+ | ||
|---|---|---|---|---|---|---|---|---|
| Overall (all causes of hospitalizations in urological departments) | n | 8,959 | 13,737 | 18,649 | 27,768 | 67,061 | 58,885 | 19,004 |
| rate per 100,000 | 184.8 | 232.0 | 317.8 | 610.6 | 1,328.0 | 1,925.8 | 1,171.3 | |
| Kidney cancer (C64) | n | 20 | 116 | 468 | 890 | 1,830 | 1,732 | 346 |
| rate per 100,000 | 0.4 | 2.0 | 8.0 | 19.6 | 36.2 | 56.6 | 21.3 | |
| Bladder cancer (C67) | n | 45 | 181 | 690 | 2,590 | 11,273 | 12,733 | 5,041 |
| rate per 100,000 | 0.9 | 3.1 | 11.8 | 56.9 | 223.2 | 416.4 | 310.7 | |
| Obstructive and reflux uropathy (N13) | n | 1,072 | 1,795 | 2,367 | 3,007 | 5,946 | 4,767 | 2,021 |
| rate per 100,000 | 22.1 | 30.3 | 40.3 | 66.1 | 117.7 | 155.9 | 124.6 | |
| Kidney and ureteral stones (N20) | n | 2,489 | 5,752 | 7,752 | 8,491 | 10,971 | 5,832 | 1,227 |
| rate per 100,000 | 51.3 | 97.1 | 132.1 | 186.7 | 217.3 | 190.7 | 75.6 | |
| Stones of lower urinary tract (N21) | n | 55 | 105 | 130 | 293 | 1,063 | 1,067 | 372 |
| rate per 100,000 | 1.1 | 1.8 | 2.2 | 6.4 | 21.0 | 34.9 | 22.9 | |
| Unspecified renal colic (N23) | n | 163 | 188 | 222 | 200 | 185 | 83 | 17 |
| rate per 100,000 | 3.4 | 3.2 | 3.8 | 4.4 | 3.7 | 2.7 | 1.0 | |
| Urethral stricture (N35) | n | 165 | 268 | 349 | 476 | 1,631 | 1,885 | 712 |
| rate per 100,000 | 3.4 | 4.5 | 5.9 | 10.5 | 32.3 | 61.6 | 43.9 | |
| Prostate cancer (C61) | n | 1 | 2 | 180 | 1,529 | 6,459 | 4,316 | 636 |
| rate per 100,000 (only males) | 0.0 | 0.1 | 6.1 | 68.3 | 278.5 | 345.0 | 127.3 | |
| Hyperplasia of prostate (N40) | n | 8 | 33 | 271 | 1,958 | 8,393 | 8,423 | 2,296 |
| rate per 100,000 (only males) | 0.3 | 1.1 | 9.2 | 87.5 | 361.9 | 673.2 | 459.7 | |
| Redundant prepuce, phimosis and paraphimosis (N47) | n | 1,472 | 638 | 586 | 552 | 883 | 782 | 374 |
| rate per 100,000 (only males) | 59.6 | 21.2 | 19.8 | 24.7 | 38.1 | 62.5 | 74.9 |
n – number of patients; SD – standard deviation
Characteristics of patients admitted to urological departments with common urological conditions
Three-quarters of patients hospitalized due to bladder cancer were males (Table 5), the mean age was 70.2 years, and the mean duration of hospitalization was 3 days. One-third of hospitalizations led to the completion of the therapeutic or diagnostic process, and 66.9% ended up with a referral for further treatment in the outpatient clinic (Table 5). Out of all patients admitted due to kidney and ureteral stones, 57.2% were males, the mean age was 54.4 years, almost one-quarter of admissions were in emergency mode, and 23.5% lasted less than 24 hours (Table 5). Most of the patients hospitalized due to obstructive and reflux uropathy were females (52.1%), the mean age was 60.4 years and 23% of patients had comorbidities. One-third of patients (30.6%) were admitted in emergency mode and 28% of hospital admissions lasted less than 24 hours (Table 5). The mean age of patients admitted due to prostate cancer was 67.3 years and the mean duration of hospitalization was 4 days (Table 6). Among patients admitted due to hyperplasia of the prostate, the mean age was 69.4 years and the mean duration of hospitalization was 2.9 days. Among males admitted due to prostate cancer or hyperplasia, approximately one-third of admissions ended up with completion of the therapeutic or diagnostic process (Table 6).
Table 5.
Epidemiological characteristics of patients admitted to urological departments due to bladder cancer, kidney and ureteral stones or uropathy in Poland in 2022
| Cause of admission to urological department | ||||||
|---|---|---|---|---|---|---|
| bladder cancer (C67) n = 32,553 | kidney and ureteral stones (N20) n = 42,504 | obstructive and reflux uropathy (N13) n = 20,975 | ||||
| Variable | n | % | n | % | n | % |
| Gender | ||||||
| male | 24,346 | 74.8 | 24,308 | 57.2 | 10,040 | 47.9 |
| female | 8,207 | 25.2 | 18,196 | 42.8 | 10,935 | 52.1 |
| Age | ||||||
| mean ±SD; median; min–max | 70.2 ±9.5 | 54.4 ±15.1 | 60.4 ±16.2 | |||
| median; min–max | 70; 18–99 | 56; 18–98 | 64; 18–104 | |||
| Type of admission | ||||||
| emergency | 3,227 | 9.9 | 9,994 | 23.5 | 6,423 | 30.6 |
| scheduled | 29,326 | 90.1 | 32,510 | 76.5 | 14,552 | 69.4 |
| Duration of hospitalization | ||||||
| mean ±SD | 3.0 ±4.4 | 2.6 ±2.7 | 2.8 ±3.7 | |||
| median; min–max | 2; 0–275 | 2; 0–98 | 2; 0–140 | |||
| <24 hours | 5,685 | 17.5 | 9,993 | 23.5 | 5,864 | 28.0 |
| 1 day | 2,191 | 6.7 | 3,179 | 7.5 | 2,294 | 10.9 |
| 2 days | 12,553 | 38.6 | 12,719 | 29.9 | 4,336 | 20.7 |
| 3 days | 4,468 | 13.7 | 6,422 | 15.1 | 2,623 | 12.5 |
| 4 days or more | 7,656 | 23.5 | 10,191 | 24.0 | 5858 | 27.9 |
| In-hospital death | ||||||
| yes | 159 | 0.5 | 28 | 0.1 | 100 | 0.5 |
| no | 32,394 | 95.5 | 42,476 | 99.9 | 20,875 | 99.5 |
| Number of hospital wards | ||||||
| 1 | 32,185 | 98.9 | 42,363 | 99.7 | 20,804 | 99.2 |
| 2 or more | 368 | 1.1 | 141 | 0.3 | 171 | 0.8 |
| Data on comorbidities reported in the registry | ||||||
| yes | 4,906 | 15.1 | 5,315 | 12.5 | 4,820 | 23.0 |
| no | 27,647 | 84.9 | 37,189 | 87.5 | 16,155 | 77.0 |
n – number of patients; SD – standard deviation
Table 6.
Epidemiological characteristics of males admitted to urological departments due to prostate diseases in Poland in 2022
| Variable | Cause of admission to urological department | |||
|---|---|---|---|---|
| prostate cancer (C61) n = 13,123 | hyperplasia of prostate (N40) n = 21,382 | |||
| n | % | n | % | |
| Age | ||||
| mean ±SD | 67.3 ±7.3 | 69.4 ±8.2 | ||
| median; min–max | 67; 29–98 | 70; 20–99 | ||
| Type of admission | ||||
| emergency | 1,111 | 8.5 | 1,546 | 7.2 |
| scheduled | 12,012 | 91.5 | 19,836 | 92.8 |
| Duration of hospitalization | ||||
| mean ±SD | 4.0 ±3.7 | 2.9 ±3.1 | ||
| median; min-max | 4; 0–121 | 2; 0–120 | ||
| <24 hours | 2,488 | 19.0 | 6,318 | 29.5 |
| 1 day | 445 | 3.4 | 1,248 | 5.8 |
| 2 days | 828 | 6.3 | 3,307 | 15.5 |
| 3 days | 2,466 | 18.8 | 3,516 | 16.4 |
| 4 days or more | 6,896 | 52.5 | 6,993 | 32.7 |
| Outcome of hospitalization In-hospital death | ||||
| yes | 30 | 0.2 | 8 | 0.0 |
| no | 13,093 | 99.8 | 21,374 | 99.9 |
| Number of hospital wards | ||||
| 1 | 13,011 | 99.1 | 21,318 | 99.7 |
| 2 or more | 112 | 0.9 | 64 | 0.3 |
| Presence of comorbidities according to discharge card | ||||
| yes | 1,651 | 12.6 | 3,639 | 17.0 |
| no | 11,472 | 87.4 | 17,743 | 83.0 |
n – number of patients; SD – standard deviation
DISCUSSION
This is the first characteristic of patients admitted to urological departments carried out based on a nationwide registry that provides detailed epidemiological data on inpatient urological care in Poland. In 2022, 214,063 hospital admissions to urological departments were reported, without markable seasonal differences in particular months. There were significant differences in the urological hospitalization rates between the administrative regions (Voivodeships) that point out potential health inequalities in urological care. Over 70% of patients admitted to urological departments were males and the most of the patients were aged 65–74 years. One-quarter of hospitalizations lasted up to 24 hours and were related to one-day surgery and diagnosis. Kidney and ureteral stones (19.9%), bladder cancer (15.2%), and hyperplasia of the prostate (10%) were the most common causes of admission to the urological department.
In 2022, over 200,000 hospital admissions to urological departments were reported, which confirms that urological care is a significant part of inpatient medical care. There were no markable seasonal differences in the number of hospital admissions per month, with a slight decrease in the first two months of the year. Since March 2022, most of the anti-epidemic restrictions have been lifted which may lead to an increase in the number of hospital admissions between February and March 2022 [23].
This nationwide registry-based study revealed significant (up to twofold) differences in urological hospitalization rates between administrative regions in Poland. This observation may result from the access to urological care services in particular regions. Moreover, further analyses are needed to assess the regional differences in the exposure to urological disease risk factors [24]. Health policymakers should use the findings from this study to reduce health inequalities in access to urological care in Poland.
Gender and age are well-known factors associated with the risk of urological diseases [25, 26]. For example, gender discrepancy exists in the incidence of kidney cancer, bladder cancer, and urolithiasis, with a higher prevalence among males [25, 26]. Findings from this study revealed that 72% of patients admitted to urological departments were males. However, the prevalence of kidney and ureteral stones was only slightly higher among males which is in line with the previously reported data on the prevalence of urolithiasis and its risk factors like obesity [27]. Out of all major causes of admission to urological departments, obstructive and reflux uropathy was more common among females than males. Older age is a risk factor for numerous urological diseases, especially among males (diseases of the prostate) [28, 29]. In 2022. the highest urological hospitalization rate was observed among adults aged 65–74 years. We can hypothesize that reaching retirement age (65 years for men) has an impact on the attitudes towards urological screening and visiting urologists that lead to hospitalization due to urological conditions. Age differences in hospital admissions to the urological department presented in this study may be used by urologists to assess the age of diagnosis of urological diseases and monitor current trends in urological disease onset.
One-day surgery and diagnosis are growing trends in healthcare, including urological care [13]. Findings from this study revealed that one-quarter of admissions to the urological department were one-day hospitalizations. This observation suggests that one-day hospitalizations are a significant part of urological care and may contribute to increasing the effectiveness of healthcare in Poland. Moreover, most of the urological hospitalizations ended within 3 days, but almost one-quarter of patients were hospitalized for 4 days or more. Over half of males admitted due to prostate cancer were hospitalized for 4 days and over. This observation suggests that particular attention should be paid to the quality of urological care of patients with prostate cancer and the development of novel techniques and surgical methods that may shorten the duration of hospitalization [30]. There were only 716 in-hospital deaths (0.3% of all urological hospitalizations) which suggests that the safety of procedures provided in urological departments is high and patients admitted to urological departments are in general good condition.
Data used in this study were collected as a part of public statistics and aggregated into a nationwide registry. Previously published data based on the same registry indicated that physicians performing one-day surgical procedures (e.g., ophthalmologists taking care of patients with cataracts) miss comorbidities in discharge records [21]. Findings from this registry-based study revealed that 16.7% of patients admitted to the urological departments had comorbidities, which is lower than the prevalence of comorbidities in a general population (up to 50% of the population) [31]. This observation suggests that urologists did not follow guidelines on data reporting on comorbidities of patients admitted to urological departments, especially patients admitted for one-day surgeries.
Practical implications
Findings from this study provide precise epidemiological data on inpatient urological care in Poland. Demographic characteristics of patients hospitalized in urological departments may be used to forecast further needs for urological care for the elderly population. Data on the duration of hospitalization and outcomes of hospitalization may be used by urologists and policymakers to evaluate the current quality of urological care in Poland. Regional differences in urological hospitalizations presented in this study point out an urgent need to remove barriers to access to urological procedures. Moreover, findings from this study suggest that data reporting should be improved and there is a need to educate urologists on the importance of public statistics and data reporting (especially those related to medical history and comorbidities) that pose a basis for policymaking. Data presented in this study may be also used for comparisons between urological departments and benchmarking related to the demographic characteristics of the patients, duration of care, and its outcome.
This is a registry-based study, and the scope of analysis is limited to data available in datasets collected within the nationwide registry. Data on procedures performed during the hospitalization were not available, so the impact of surgical techniques on the outcomes of hospitalizations was not analyzed. Datasets were anonymous, so patients re-hospitalized after 30 days from the first admission cannot be identified. Data on comorbidities should be analyzed carefully, as the low prevalence of comorbidities presented in this study may result from the insufficient attention paid to the data coding (mostly in patients admitted to one-day surgical procedures) by physicians rather than the health status of the population.
CONCLUSIONS
This study revealed that most of the patients admitted to urological departments were males and the significant peak in hospital admissions was observed after 60 years of age. Significant regional differences in the hospitalization rates in urological departments were observed. Almost every fourth patient admitted to the urological department was discharged within 24 hours. Kidney and ureteral stones, bladder cancer, and prostate hyperplasia were the most common causes of hospital admis-sions. Data presented in this study may be used by physicians and policymakers to evaluate and im-prove inpatient urological care in Poland (especially access to healthcare services and quality of data reporting) and forecast demand for urological care.
ACKNOWLEDGEMENTS
We are grateful to the Department of Population Health Monitoring and Analysis, National Institute of Public Health – National Research Institute in Warsaw for data sharing.
CONFLICT OF INTERESTS
Authors declare no conflict of interest.
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