MP75-15 THE CONSEQUENCES OF DELAYING STONE TREATMENT

Abstract

You have accessJournal of UrologyStone Disease: Evaluation I1 Apr 2015MP75-15 THE CONSEQUENCES OF DELAYING STONE TREATMENT Justin Friedlander, Nicholas Kavoussi, Shuvro De, Asim Ozayar, Nabeel Shakir, Jodi Antonelli, and Margaret Pearle Justin FriedlanderJustin Friedlander More articles by this author , Nicholas KavoussiNicholas Kavoussi More articles by this author , Shuvro DeShuvro De More articles by this author , Asim OzayarAsim Ozayar More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Margaret PearleMargaret Pearle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As the prevalence of nephrolithiasis has increased, so has the need for surgery to treat stones. This is particularly relevant at publically-funded hospitals with limited resources, including operative time, leading to potential delays in care for patients with stones. Consequently, drainage procedures to stabilize the patient and protect renal function may be necessary until definitive treatment can be offered. We sought to evaluate the impact of time to stone treatment on patient morbidity and healthcare resource utilization. METHODS Using billing records, we identified consecutive patients undergoing surgical stone procedures (shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy) performed at our county hospital between January 2011 and December 2013 and reviewed their charts from the time of initial presentation with their stone to the time of definitive surgical intervention. We recorded clinical outcomes, including need for temporizing drainage procedures and unplanned hospital encounters, from diagnosis to treatment. RESULTS During the study period, a total of 795 patients underwent definitive surgical treatment for stones. The median time from diagnosis to surgery was 79 days (range 0-1147 days). A total of 199 patients underwent temporizing drainage with a stent (n=125) or a nephrostomy tube (n=74) and 52 of these patients required at least one or more tube changes before treatment. A total of 714 unplanned encounters (emergency department (ED) or clinic visits) were required for 432 patients (54.3%), including 89 patients (11.2%) who required hospital admission. Multivariate adjusted analysis revealed that patients treated > 45 days after diagnosis were 15.2 times (95% CI 8.4-30.6, p<0.0001) more likely to have an unplanned clinic visit; 3.6 times (95% CI 2.6-5.2, p<0.0001) more likely to have an unplanned ED visit; 5.7 times (95% CI 3.9-8.4, p<0.0001) more likely to have additional imaging studies performed and 5.4 times (95% CI 3.2-9.4, p<0.0001) more likely to have a positive urine culture requiring antibiotics than patients treated within 45 days of initial diagnosis. CONCLUSIONS Longer time interval between diagnosis and treatment of stones is associated with increased patient morbidity and more frequent use of imaging studies and antibiotics. The use of temporizing drainage procedures may provide the false impression that treatment can be safely deferred. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLee W, Chen A, Kalil R, Cohen T, Berg W, Waltzer W, Kim J and Adler H (2017) Medicaid Patients Experience Longer Wait Times at Academic Urology Clinics Compared to Patients with MedicareUrology Practice, VOL. 5, NO. 5, (360-366), Online publication date: 1-Sep-2018. Volume 193Issue 4SApril 2015Page: e953 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Friedlander More articles by this author Nicholas Kavoussi More articles by this author Shuvro De More articles by this author Asim Ozayar More articles by this author Nabeel Shakir More articles by this author Jodi Antonelli More articles by this author Margaret Pearle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...