1383 SHOCK WAVE LITHOTRIPSY VERSUS URETEROSCOPY: VARIATION IN SURGICAL MANAGEMENT OF PEDIATRIC UROLITHIASIS AT AMERICAN PEDIATRIC HOSPITALS

Abstract

You have accessJournal of UrologyPediatrics: Stone Disease & Tumors1 Apr 20111383 SHOCK WAVE LITHOTRIPSY VERSUS URETEROSCOPY: VARIATION IN SURGICAL MANAGEMENT OF PEDIATRIC UROLITHIASIS AT AMERICAN PEDIATRIC HOSPITALS HsinHsiao Wang, Jonathan Routh, Lin Huang, and Caleb Nelson HsinHsiao WangHsinHsiao Wang Boston, MA More articles by this author , Jonathan RouthJonathan Routh Boston, MA More articles by this author , Lin HuangLin Huang Boston, MA More articles by this author , and Caleb NelsonCaleb Nelson Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1228AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In recent years retrograde ureteroscopy (URS) has become increasingly common in the surgical treatment for pediatric urolithiasis. The factors determining procedure choice between shock wave lithotripsy (SWL) and URS are unclear. We sought to identify patient and hospital factors associated with the choice between SWL and URS for children undergoing lithotripsy surgery. METHODS The Pediatric Health Information System (PHIS) is a national database of free-standing children's hospitals. Using ICD-9 diagnosis and procedure codes, we searched PHIS to identify patients with urolithiasis who underwent SWL or URS (inpatient or outpatient) between 2000 and 2008 at PHIS hospitals that provided both inpatient and outpatient data (n=27). For analysis of factors associated with procedure choice, we limited analysis to hospitals performing both procedures during the study period (n=16). We used multivariate logistic regression models to evaluate whether the type of procedure performed was associated with hospital-level factors and patient features. RESULTS We identified 3377 children with urolithiasis, of whom 538 (16%) underwent surgery (48% SWL, 52% URS) at a PHIS hospital. 1 hospital performed only SWL, 10 hospitals performed only URS, and 16 hospitals performed both procedures during the study period. Procedures on 445 patients at hospitals providing both procedures were included for comparison of factors. The proportion of URS cases (vs. SWL) increased during the study period (27% during the first half vs. 46% during the second half, p=0.0007). Procedure choice was not significantly associated with patient age (p=0.2), gender (p=0.1), race (p=0.07), or insurance (p=0.9). On the hospital level, SWL was more common at hospitals in larger metropolitan area (p=0.002) or the Northeast and Midwest rather than the West (p=0.05). Hospital size (p=0.6) and teaching hospital status (p=1.0) were not associated with SWL/URS preference. After adjusting for the covariates, the treating hospital was the most important factor predicting procedure choice. The proportion of URS cases varied by hospital from 6% to 88%. CONCLUSIONS There is a wide range of utilization of URS versus SWL for children with urolithiasis treated at U.S. children's hospitals . Althought the clinical features that drive procedure choice should be similar at facilities that offer both modalities, decision-making appears to depend very significantly upon the hospital at which a patient receives treatment. This level of clinical variation is potentially concerning. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e552 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information HsinHsiao Wang Boston, MA More articles by this author Jonathan Routh Boston, MA More articles by this author Lin Huang Boston, MA More articles by this author Caleb Nelson Boston, MA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...