PD54-04 THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE APPROPRIATENESS CRITERIA FOR URETERAL STENT OMISSION FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URINARY STONE DISEASE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-04 THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE APPROPRIATENESS CRITERIA FOR URETERAL STENT OMISSION FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URINARY STONE DISEASE Spencer C. Hiller, Stephani Daignault-Newton, S. Mohammad Jafri, Ronald Rubenstein, Mazen Abdelhady, C. Peter Fischer, Elena Gimenez, Richard Sarle, William W. Roberts, Conrad Maitland, Rafid Yousif, Robert Elgin, Laris Galejs, Jeremy Konheim, David Leavitt, Eric Stockall, J. Rene Frontera, J. Stuart Wolf, John M. Hollingsworth, Casey A. Dauw, Khurshid R. Ghani, and for the Michigan Urological Surgery Improvement Collaborative Spencer C. HillerSpencer C. Hiller More articles by this author , Stephani Daignault-NewtonStephani Daignault-Newton More articles by this author , S. Mohammad JafriS. Mohammad Jafri More articles by this author , Ronald RubensteinRonald Rubenstein More articles by this author , Mazen AbdelhadyMazen Abdelhady More articles by this author , C. Peter FischerC. Peter Fischer More articles by this author , Elena GimenezElena Gimenez More articles by this author , Richard SarleRichard Sarle More articles by this author , William W. RobertsWilliam W. Roberts More articles by this author , Conrad MaitlandConrad Maitland More articles by this author , Rafid YousifRafid Yousif More articles by this author , Robert ElginRobert Elgin More articles by this author , Laris GalejsLaris Galejs More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , David LeavittDavid Leavitt More articles by this author , Eric StockallEric Stockall More articles by this author , J. Rene FronteraJ. Rene Frontera More articles by this author , J. Stuart WolfJ. Stuart Wolf More articles by this author , John M. HollingsworthJohn M. Hollingsworth 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.0000000000002081.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are associated with pain and urinary symptoms. Despite guidelines recommending stent omission following uncomplicated ureteroscopy (URS), they are frequently placed. We sought to define clinical scenarios suitable for stent omission by use of the RAND/UCLA Appropriateness Methodology. METHODS: We convened a panel of 15 urologists representing diverse practices from the Michigan Urological Surgery Improvement Collaborative (MUSIC). Panelists defined uncomplicated URS and agreed on 7 variables that influence stent decision-making: stone size, location, pre-stenting, urinalysis/culture result, ureteral dilation, ureteral access sheath, fragment status. Over 2 rounds, panelists scored 144 clinical scenarios for stent omission appropriateness based on all combinations of variables, from 1 (highly inappropriate) to 9 (highly appropriate). Median scores 1 to 3 were inappropriate; 4 to 6, uncertain; and 7 to 9, appropriate. Multivariable analysis was used to determine the odds of each variable being scored appropriate for omission. Panel findings were then applied to prior stenting practices for uncomplicated URS within MUSIC. RESULTS: Of the 144 scenarios, 88 (61%) were inappropriate for omission and 26 (18%) were appropriate for omission (Fig. 1). All variables impacted stent omission decision-making (Fig. 2). Stenting rates in MUSIC correlated with panel results (Fig. 3). Among cases highly appropriate for omission, stents had been placed in 55%. CONCLUSIONS: We identified 26 clinical scenarios appropriate for stent omission. Implementation of these results into real-world practice will help reduce stenting rates, with the goal to decrease patient morbidity and improve the quality of care. Source of Funding: Blue Cross Blue Shield of Michigan © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e923-e924 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer C. Hiller More articles by this author Stephani Daignault-Newton More articles by this author S. Mohammad Jafri More articles by this author Ronald Rubenstein More articles by this author Mazen Abdelhady More articles by this author C. Peter Fischer More articles by this author Elena Gimenez More articles by this author Richard Sarle More articles by this author William W. Roberts More articles by this author Conrad Maitland More articles by this author Rafid Yousif More articles by this author Robert Elgin More articles by this author Laris Galejs More articles by this author Jeremy Konheim More articles by this author David Leavitt More articles by this author Eric Stockall More articles by this author J. Rene Frontera More articles by this author J. Stuart Wolf More articles by this author John M. Hollingsworth 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 Loading ...