Patients admitted to the hospital with an acute, non-infected episode of urolithiasis are candidates for medical expulsive therapy, ureteral stent placement or upfront ureteroscopy. We sought to assess socioeconomic factors influencing treatment decisions in managing urolithiasis and to determine differences in outcomes based on treatment modality.
The Healthcare Cost and Utilization Project State Inpatient Database, State Ambulatory Surgery and Services Database, and State Emergency Department Database for California from 2007-2011 and Florida from 2009-2014 were utilized. Patients who were admitted to the hospital with a primary diagnosis of kidney or ureteral stone were identified. The initial treatment modality utilized was assessed and factors that influenced that decision were analyzed. Multivariate logistic regression model was fit to determine factors independently associated with upfront ureteroscopy. Lastly, outcomes of non-infected patients who underwent stent alone vs ureteroscopy were compared.
We identified 146,199 patients who had an inpatient admission with urolithiasis. Overall, 45% of patients had no intervention at the time of their evaluation. Of the 55% of patients who underwent surgical intervention, 42% underwent stent alone, 44% underwent upfront ureteroscopy, 1% had a PCN tube placement, 8% underwent ESWL while 5% underwent PCNL. On multivariate logistic regression model, minorities, younger patients, publically/uninsured patients, more comorbid patients, those admitted on the weekends and patients admitted to an academic institution had significantly lower odds of undergoing upfront ureteroscopy. Secondary analysis demonstrated clinical and economic advantages of upfront ureteroscopy vs stent alone in eligible patients.
Upfront ureteroscopy is an overlooked procedure that has clinical and cost saving implications. Unfortunately, minorities, publically insured patients, and those admitted on the weekend are less likely to undergo upfront ureteroscopy, a disparity that should be addressed by urologist.
Journal of endourology. 2019 Jan 05 [Epub ahead of print]
Eric Kirshenbaum, Chirag Doshi, Ryan Dornbier, Robert H Blackwell, Petar Bajic, Gopal N Gupta, Alex Gorbonos, Thomas Turk, Robert C Flanigan, Kristen Baldea
Loyola University Medical Center, 25815, Maywood, Illinois, United States ; ., Loyola University Medical Center, 25815, Maywood, Illinois, United States ; ., Loyola University Medical Center, 25815, Department of Urology , 2160 S First Ave. , Fahey Center , Room 241 , Maywood, Illinois, United States , 60153-5590 ; ., Southern Illinois University School of Medicine, 12249, Springfield, Illinois, United States ; ., Urology, Maywood, United States ; ., Loyola University Medical Center, Urology , 2160 S. 1st Avenue , Maywood, Illinois, United States , 60153 ; ., Loyola University Medical Center, 25815, Maywood, Illinois, United States ; ., Loyola University Medical , Urology , 2160 S. First Ave , Maywood, United States , IL ; ., Loyola University Stritch School of Medicine, Urology, Maywood, Illinois, United States ; ., Loyola University Medical Center, Urology, Maywood, Illinois, United States ; .