Increasing medical complexity among inpatients in urology over time: A comparative retrospective chart review.

Abstract

Introduction: This study aimed to evaluate temporal trends in the medical complexity of urologic inpatients and investigate their implications for clinical care delivery.

Methods: A retrospective comparative chart review was conducted for urologic inpatients admitted to a tertiary care center during two time periods: 2006-2007 and 2019-2020. A random sample of 150 patient charts from each cohort (N=300) was analyzed using a structured data extraction protocol in REDCap. Indicators of medical complexity included comorbidities, polypharmacy, and healthcare resource utilization. Statistical analyses comprised independent-samples t-tests, logistic regression, and multiple linear regression modeling.

Results: Analysis of 300 patient records revealed a significant increase in medical complexity in the contemporary cohort compared to the historical cohort. Patients admitted in 2019-2020 exhibited higher Charlson comorbidity index scores, a greater number of chronic conditions, and increased polypharmacy. Utilization of home care services and specialist consultations during hospitalization was also more prevalent in the contemporary cohort. Although length of stay (LOS) remained comparable between cohorts, open abdominal surgery and the number of prescription medications were significant predictors of prolonged LOS (p<0.05).

Conclusions: The medical complexity of urologic inpatients has escalated over time, driven by increased comorbid burden and healthcare system interactions. Despite advances in surgical techniques that would traditionally reduce LOS, these improvements may be counterbalanced by the growing complexity of patient populations. Interventions such as pre-admission optimization and integrated multidisciplinary care are essential to address the challenges posed by this evolving clinical landscape.