PD45-11 DOES THE USE OF A URETERAL ACCESS SHEATH REDUCE INFECTION-RELATED HOSPITALIZATION? REAL-WORLD DATA FROM A SURGICAL COLLABORATIVE

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD45-11 DOES THE USE OF A URETERAL ACCESS SHEATH REDUCE INFECTION-RELATED HOSPITALIZATION? REAL-WORLD DATA FROM A SURGICAL COLLABORATIVE Russelle. N. Becker, Andrew M. Higgins, Golena Fernandez Moncaleano, Sung Yong Cho, Mohammad Jafri, Jessica Phelps, Jeremy Konheim, Bronson Conrado, Monica S. Van Til, Stephanie Daignault-Newton, Casey A. Dauw, Khurshid R. Ghani, and For The Michigan Urological Surgery IMPROVEMENT Collaborative Russelle. N. BeckerRusselle. N. Becker More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Jessica PhelpsJessica Phelps More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Monica S. Van TilMonica S. Van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani 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.0000000000003358.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elevated intrarenal pressure during ureteroscopy (URS) may result in pyelovenous backflow, which is hypothesized to increase the risk of sepsis. When treating renal stones, the ureteral access sheath (UAS) is considered a pressure mitigation strategy, yet evidence on whether a UAS reduces infectious complications is unclear. Prior studies are limited by small cohorts, heterogenous inclusion criteria, ambiguous endpoints, or lack adequate risk adjustment. We examined UAS use when treating renal stones and its association with infection-related hospitalization in a statewide registry. METHODS: Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all patients undergoing single-stage unilateral URS for renal stones, with or without the use of a UAS. We assessed variation in UAS in practices with>10 cases. We evaluated demographic differences between cases with or without UAS. A multivariable logistic regression model was constructed to examine the impact of UAS use and other patient, stone, and surgical factors on 30-day infection-related hospitalization. RESULTS: Among 6,142 patients undergoing URS by 233 urologists across 34 practices, 152 (2.5%) had an infection-related hospitalization within 30 days. Patients with UAS had significantly larger stones, more positive preoperative urine culture, and higher comorbidity. Overall 59% of cases utilized UAS, with significant variation between practices (4.1% to 99.5%, p<0.0001; Figure). Infection-related hospitalization rates were no different for cases with (2.6%) vs. without (2.3%) UAS use (p=0.5). On multivariable analysis, infection-related hospitalizations did not differ by UAS (OR 0.8; 95% CI 0.6 - 1.2; p=0.4), but were associated with higher Charlson Comorbidity Index (CCI 1 vs. 0, OR 1.9; 95% CI 1.2 - 2.9; CCI 2+ vs. 0, OR 2.3; 95% CI 1.4 - 3.6; p<0.001), history of recurrent UTI (OR 2.4; 95% CI 1.4 - 4.0; p<0.01), larger stones (OR per 5mm 1.1; 95% CI 1.0 - 1.3; p=0.04), and positive preoperative urine culture (OR 1.8; 95% CI 1.2 - 2.7; p<0.01). CONCLUSIONS: Utilization of UAS when treating renal stones varies widely across practices within Michigan. UAS did not reduce infection-related hospitalization following URS for renal stones. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1167 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russelle. N. Becker More articles by this author Andrew M. Higgins More articles by this author Golena Fernandez Moncaleano More articles by this author Sung Yong Cho More articles by this author Mohammad Jafri More articles by this author Jessica Phelps More articles by this author Jeremy Konheim More articles by this author Bronson Conrado More articles by this author Monica S. Van Til More articles by this author Stephanie Daignault-Newton More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...