MP6-18 THE IMPACT OF UNPLANNED POST-PROCEDURE VISITS ON THE MANAGEMENT OF PATIENTS WITH URINARY STONES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-18 THE IMPACT OF UNPLANNED POST-PROCEDURE VISITS ON THE MANAGEMENT OF PATIENTS WITH URINARY STONES Charles Scales, Christopher Saigal, Janet Hanley, Andrew Dick, Claude Setodji, and Mark Litwin Charles ScalesCharles Scales More articles by this author , Christopher SaigalChristopher Saigal More articles by this author , Janet HanleyJanet Hanley More articles by this author , Andrew DickAndrew Dick More articles by this author , Claude SetodjiClaude Setodji More articles by this author , and Mark LitwinMark Litwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.252AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Unplanned follow-up care is the focus of intense health policy interest, as evidenced by recent financial penalties imposed for hospital re-admissions under the Affordable Care Act. To date, however, unplanned post-procedural care remains poorly characterized, particularly for patients with kidney stones. Our objective was to describe the frequency, variation and financial impact of unplanned, high-acuity follow-up visits in the treatment of patients with renal and ureteral stones. METHODS We identified privately insured patients undergoing percutaneous nephrostolithotomy, ureteroscopy, or shock wave lithotripsy for stone disease. The primary outcome (an unplanned visit) was occurrence of an emergency department visit or hospital admission within 30 days of the procedure. Admissions for second-look percutaneous nephrostolithotomy were excluded. Multivariable models estimated the odds of an unplanned visit and the incremental cost of those visits, controlling for important covariates. RESULTS We identified 93,523 initial procedures to fragment or remove stones. Among these patients, 54,267 (58%) were male, and most (71%) were aged between 31 and 55 years. Overall, 1 in 7 patients had an unplanned post-procedural visit. The most common diagnoses for these visits included pain, infection, bleeding and renal failure. Unplanned visits were least common following shock wave lithotripsy (12%), and occurred with similar frequency after ureteroscopy and percutaneous nephrostolithotomy (15%). Procedures at high-volume facilities were substantially less likely to result in an unplanned visit (OR 0.80, 95% CI 0.74–0.87, P<0.001). Patients with greater comorbidity were more likely to experience an unplanned visit. When an unplanned visit occurred, adjusted incremental expenditures per episode were greater after shock wave lithotripsy [$32,156 (95% CI $30,453–33,859)] than after ureteroscopy [$23,436 (95% CI $22,281–24,590)]. CONCLUSIONS Patients not infrequently experience an unplanned, high-acuity visit after low-risk procedures to remove urinary stones, and the cost of these encounters is substantial. Interventions are indicated to identify and reduce preventable unplanned visits. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e63 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Charles Scales More articles by this author Christopher Saigal More articles by this author Janet Hanley More articles by this author Andrew Dick More articles by this author Claude Setodji More articles by this author Mark Litwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...