PD15-03 PATTERNS OF UNPLANNED HEALTHCARE ENCOUNTERS AND OUTCOMES FOR PROXIMAL URETERAL STONES UNDERGOING URETEROSCOPY OR SHOCKWAVE LITHOTRIPSY IN A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE

Abstract

INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) and shockwave lithotripsy (SWL) are standard treatments for patients presenting with proximal ureteral stones. Contemporary data comparing Emergency Department (ED) visits and hospitalization between these therapies is lacking. In this study we compared outcomes between URS and SWL for proximal ureteral stones in a statewide quality improvement collaborative. METHODS: Michigan Urological Surgery Improvement Collaborative’s Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) is a prospective clinical registry of patients undergoing URS and SWL for stone disease. We compared clinical and surgical factors between patients undergoing URS and SWL for proximal ureteral stones from June 2016-July 2019 using bivariate statistics. Using multivariate logistic regression controlling for practice variation as well as clinical and surgical factors, we assessed whether URS was independently associated with ED visits or hospitalizations within 30 days of surgery, need for repeat procedure on the same side within 3 months, and stone-free status relative to SWL. RESULTS: A total of 3150 proximal ureteral stones were identified, 76% (2393) were treated with URS and 24% (757) were treated with SWL. Rates of URS compared to SWL for treatment of proximal ureteral stones varied greatly between providers (Fig 1). On multivariate analysis, URS cases had a significantly increased odds of having an ED visit relative to SWL (OR 2.05; 95%CI 1.13-3.72 p=0.02) but were not at a significantly increased risk for hospitalization (OR 1.44; 95%CI 0.61-3.36 p=0.4). URS cases also had a significantly decreased odds of requiring an additional procedure (OR 0.12; 95%CI 0.07-0.19 p<0.001) and significantly increased odds of being stone-free (OR 2.01; 95%CI 1.4-2.89 p<0.001) relative to SWL. CONCLUSIONS: URS for proximal ureteral stones has a benefit compared to SWL with regard to stone-free rate and need for additional procedures but at the cost of an increased risk of ED visit. Clinicians may use this data to counsel patients on the risks of each procedure. Further analysis may reveal specific factors, such as BMI and prior stent placement, that contribute to these disparate outcomes.Source of Funding: Blue Cross Blue Shield of Michigan