NEW ORLEANS, LA USA (UroToday.com) - Over the years there has been an increased prevalence of nephrolithiasis, resulting in an increased need for surgery. A major concern in hospitals with limited resources and funding is the potential delay in operative time, which could require drainage procedures to stabilize the patient and to protect renal function until definitive treatment can be made available. Therefore, the authors of this study addressed this concern by examining the impact of time to stone treatment, specifically on patient morbidity and health care resource utilization.
Through the use of billing records at a publically-funded hospital, the authors identified 795 consecutive patients over a 2-year period (January 2011 – December 2013) who were undergoing either of the following surgical stone procedures: shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. Patient charts were reviewed in order to determine the time between initial stone diagnosis and definitive surgical intervention. The clinical outcomes that were recorded from diagnosis to surgical treatment consisted of the need for temporizing drainage procedures as well as unplanned hospital encounters.
The authors found the median time from diagnosis to surgery was 79 days. Of the 795 participating patients, 199 underwent drainage with a stent or nephrostomy tube while 714 experienced unplanned encounters, such as emergency department (ED) or clinical visits, and hospital admission. An adjusted analysis showed that patients surgically treated more than 45 days after diagnosis were 15.2 times more likely to have an unplanned clinical visit, 3.6 times more likely to have an unplanned ED visit, 5.7 times more likely to have additional imaging studies performed, and 5.4 times more likely to have a positive urine culture leading to antibiotic administration in comparison to those treated within 45 days of diagnosis.
These results were found to be statistically significant, concluding that there is a present association between a longer time interval from diagnosis to treatment of stones and increased patient morbidity and an increased frequent use of imaging studies and antibiotic administration. The authors also emphasized that temporizing drainage procedures can often times provide a false impression that a definitive, surgical treatment can be safely delayed. Therefore, to ensure a greater outcome for the patient, it is best to act quickly after initial stone diagnosis.
Presented by Nicholas Kavoussi at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of Texas Southwestern Medical Center, Dallas, TX USA
Reported by Rebecca Do (University of California-Irvine), medical writer for UroToday.com