PD01-09 URETERAL STENT PLACEMENT FOLLOWING URETEROSCOPY INCREASES EMERGENCY DEPARTMENT VISITS IN A STATEWIDE QUALITY IMPROVEMENT INITIATIVE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I (PD01)1 Apr 2020PD01-09 URETERAL STENT PLACEMENT FOLLOWING URETEROSCOPY INCREASES EMERGENCY DEPARTMENT VISITS IN A STATEWIDE QUALITY IMPROVEMENT INITIATIVE Spencer C Hiller*, Kavya Swarna, Jill Slayton, Hector Pimentel, John Ludlow, Sapan Ambani, John Hollingsworth, Khurshid R Ghani, Casey Dauw, and for the Michigan Urological Surgery Improvement Collaborative Spencer C Hiller*Spencer C Hiller* More articles by this author , Kavya SwarnaKavya Swarna More articles by this author , Jill SlaytonJill Slayton More articles by this author , Hector PimentelHector Pimentel More articles by this author , John LudlowJohn Ludlow More articles by this author , Sapan AmbaniSapan Ambani More articles by this author , John HollingsworthJohn Hollingsworth More articles by this author , Khurshid R GhaniKhurshid R Ghani More articles by this author , Casey DauwCasey Dauw More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000821.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are commonly placed after ureteroscopy (URS). Though studies indicate that stent placement is associated with transient patient discomfort, their impact on downstream health services use is less clear. We examined ureteral stent utilization in the state of Michigan as well as their impact on unplanned healthcare encounters. METHODS: We used data from the Michigan Urologic Surgery Improvement Collaborative Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) clinical registry to identify all patients that underwent URS for urinary stone disease between June 2016 and May 2019. Demographic and clinical factors associated with ureteral stent placement were examined using bivariate and multivariate statistics. We assessed variation in stent utilization at a provider level. Using multivariable logistic regression, we evaluated whether ureteral stent placement was independently associated with emergency department (ED) visits and hospitalizations within 30 days of surgery relative to patients in whom a stent was not used. RESULTS: We identified 9682 primary URS cases. A ureteral stent was placed in 73% (7025) of cases. On multivariate analysis controlling for provider variation, the factors associated with stent use included older age, greater comorbidity, larger stone size, hydronephrosis, and ureteral dilation or access sheath use at the time of surgery. Patients in whom a stent was placed preoperatively were less likely to have a stent placed postoperatively. Ureteral stent use across the 137 providers varied (range 11-100%; Figure). On multivariate analysis, controlling for clinical characteristics and provider variation, patients who had a ureteral stent placed at the time of URS had a 31% higher odds of ED visit (OR 1.31; 95% CI 1.03 – 1.66 p=0.03) but did not have a significantly increased odds of hospitalization (OR 1.27; 95% CI 0.9-1.8 p=0.18). CONCLUSIONS: There is substantial variation in the use of ureteral stents after URS in Michigan. Patients in whom a ureteral stent is placed after surgery have a significantly greater odds of an ED visit. Efforts should be made to identify patients suitable for stent omission in order to decrease unplanned health encounters after URS. Source of Funding: Blue Cross Blue Shield of Michigan © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e63-e63 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer C Hiller* More articles by this author Kavya Swarna More articles by this author Jill Slayton More articles by this author Hector Pimentel More articles by this author John Ludlow More articles by this author Sapan Ambani More articles by this author John Hollingsworth More articles by this author Khurshid R Ghani More articles by this author Casey Dauw More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...