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Emergency department and hospital revisits after ambulatory surgery for kidney stones: an analysis of the Healthcare Cost and Utilization Project

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Abstract

Our objective was to identify the rate of revisit to either emergency department (ED) or inpatient (IP) following surgical stone removal in the ambulatory setting, and to identify factors predictive of such revisits. To this end, the AHRQ HCUP ambulatory, IP, and ED databases for NY and FL from 2010 to 2014 were linked. Cases were selected by primary CPT for shock-wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL) with accompanying ICD-9 for nephrolithiasis. Cystoscopy (CYS) was selected as a comparison group. The risk of revisit was explored using multivariate models. The overall unplanned revisit rate following stone removal was 6.4% (4.2% ED and 2.2% IP). The unadjusted revisit rates for SWL, URS, and PNL are 5.9%, 6.8%, and 9.0%, respectively. The adjusted odds of revisit following SWL, URS, and PNL are 1.93, 2.25, and 2.70 times higher, respectively, than cystoscopy. The majority of revisits occurred within the first two weeks of the index procedure, and the most common reasons for revisit were due to pain or infection. Younger age, female sex, lower income, Medicare or Medicaid insurance, a higher number of chronic medical conditions, and hospital-owned surgery centers were all associated with an increased odds of any revisit. The most important conclusions were that ambulatory stone removal has a low rate of post-operative revisits to either the ED or IP, there is a higher risk of revisit following stone removal as compared to urological procedures that involve only the lower urinary tract, and demographic factors appear to have a moderate influence on the odds of revisit.

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Code availability

Stata 15.1 software used for coding; all definitions discussed in text.

Abbreviations

URS:

Ureteroscopy

SWL:

Shockwave lithotripsy

PNL:

Percutaneous nephrolithotomy

ED:

Emergency department

IP:

Inpatient hospitalization

HCUP:

Healthcare Cost and Utilization Project

AHRQ:

Agency for Healthcare Research and Quality

FL:

Florida

NY:

New York

References

  1. Scales CD, Smith AC, Hanley JM et al (2012) Prevalence of kidney stones in the United States. Eur Urol 62:160–165

    Article  Google Scholar 

  2. Hollingsworth JM, Saigal CS, Lai JC et al (2012) Surgical quality among medicare beneficiaries undergoing outpatient urological surgery. J Urol 188:1274–1278

    Article  Google Scholar 

  3. Raheem OA, Mirheydar HS, Miller DL et al (2015) Contemporary trends in the ambulatory surgical treatment of urolithiasis: population-based analysis. J Endourol 29:1189–1192

    Article  Google Scholar 

  4. Patel HD, Matlaga BR, Ziemba JD (2019) Trends in the setting and cost of ambulatory urological surgery: an analysis of 5 states in the healthcare cost and utilization project. Urol Pract 6:79–85

    Article  Google Scholar 

  5. Bas O, Bakirtas H, Sener NC et al (2014) Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones. Urolithiasis 42:115–120

    Article  Google Scholar 

  6. Sinclair AM, Gunendran T, Pearce I (2007) Day-case urological surgery: are we improving? BJU Int 99:491–493

    Article  Google Scholar 

  7. Rambachan A, Matulewicz RS, Pilecki M et al (2014) Predictors of readmission following outpatient urological surgery. J Urol 192:183–188

    Article  Google Scholar 

  8. Scales CD, Saigal CS, Hanley JM et al (2014) The impact of unplanned postprocedure visits in the management of patients with urinary stones. Surgery 155:769–775

    Article  Google Scholar 

  9. Bechis SK, Han DS, Abbott JE et al (2018) Outpatient percutaneous nephrolithotomy: the UC San Diego health experience. J Endourol 32:394–401

    Article  Google Scholar 

  10. Beiko D, Elkoushy MA, Kokorovic A et al (2015) Ambulatory percutaneous nephrolithotomy: what is the rate of readmission? J Endourol 29:410–414

    Article  Google Scholar 

  11. Schoenfeld D, Zhou T, Stern JM (2019) Outcomes for patients undergoing ambulatory percutaneous nephrolithotomy. J Endourol 33:189–193

    Article  Google Scholar 

  12. Zhao Z, Sun H, Wu X et al (2019) Evaluation of day-care versus inpatient mini-percutaneous nephrolithotomy: a propensity score-matching study. Urolithiasis. https://doi.org/10.1007/s00240-019-01160-y

    Article  PubMed  Google Scholar 

  13. Jones P, Bennett G, Dosis A et al (2018) Safety and efficacy of day-case percutaneous nephrolithotomy: a systematic review from european society of uro-technology. Eur Urol Focus. https://doi.org/10.1016/j.euf.2018.04.002

    Article  PubMed  Google Scholar 

  14. Bloom J, Matthews G, Phillips J (2016) Factors influencing readmission after elective ureteroscopy. J Urol 195:1487–1491

    Article  Google Scholar 

  15. Ghosh A, Oliver R, Way C et al (2017) Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years. World J Urol 35:1757–1764

    Article  Google Scholar 

  16. Lu CH, Kuo JY, Lin TP et al (2017) Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis. J Chin Med Assoc 80:551–557

    Article  Google Scholar 

  17. HCUP State Ambulatory Surgery and Services Databases (SASD) (2018) File composition: healthcare cost and utilization project

  18. HCUP (2018) Supplemental variables for revisit analyses: healthcare cost and utilization project

  19. de la Rosette J, Denstedt J, Geavlete P et al (2014) The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol 28:131–139

    Article  Google Scholar 

  20. Khanna A, Fedrigon D 3rd, Monga M et al (2019) Postoperative emergency department visits after urinary stone surgery: variation based on surgical modality. J Endourol. https://doi.org/10.1089/end.2019.0399

    Article  PubMed  Google Scholar 

  21. Friedlander DF, Krimphove MJ, Cole AP et al (2020) Care setting as a modifiable predictor of perioperative cost and outcomes following elective urinary stone surgery. Urol Pract 7:259–265

    Article  Google Scholar 

  22. Armitage JN, Withington J, van der Meulen J et al (2014) Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database. BJU Int 113:777–782

    Article  Google Scholar 

  23. Buldu I, Tepeler A, Karatag T et al (2016) Which factors affect the hospital re-admission and re-hospitalization after flexible ureterorenoscopy for kidney stone? World J Urol 34:1291–1295

    Article  Google Scholar 

  24. Kumar M, Pandey S, Aggarwal A et al (2018) Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi. Investig Clin Urol 59:321–327

    Article  Google Scholar 

  25. Tepeler A, Karatag T, Tok A et al (2016) Factors affecting hospital readmission and rehospitalization following percutaneous nephrolithotomy. World J Urol 34:69–73

    Article  Google Scholar 

  26. Du K, Wang RS, Vetter J et al (2018) Unplanned 30-day encounters after ureterorenoscopy for urolithiasis. J Endourol. https://doi.org/10.1089/end.2018.0177

    Article  PubMed  Google Scholar 

  27. Keskin SK, Danacioglu YO, Turan T et al (2019) Reasons for early readmission after percutaneous nephrolithotomy and retrograde intrarenal surgery. Wideochir Inne Tech Maloinwazyjne 14:271–277

    PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge the American Urological Association for support through an American Urological Association Data Grant that made purchasing this data possible.

Funding

The data for this project was funded by a 2017 American Urological Association Data Grant.

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Authors and Affiliations

  1. Division of Urology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, 3 West Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA

    Katharine F. Michel & Justin B. Ziemba

  2. Department of Urology, Loyola University Medical Center, Maywood, IL, USA

    Hiten D. Patel

Authors
  1. Katharine F. Michel
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  2. Hiten D. Patel
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  3. Justin B. Ziemba
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Correspondence to Justin B. Ziemba.

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Michel, K.F., Patel, H.D. & Ziemba, J.B. Emergency department and hospital revisits after ambulatory surgery for kidney stones: an analysis of the Healthcare Cost and Utilization Project. Urolithiasis 49, 433–441 (2021). https://doi.org/10.1007/s00240-021-01252-8

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  • DOI: https://doi.org/10.1007/s00240-021-01252-8

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