TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: Limited resources at publically funded hospitals may demand that definitive surgical intervention for stones be delayed weeks or months, necessitating drainage to stabilize the patient and protect renal function. We sought to analyze the impact of time to treatment on patient morbidity and healthcare resource utilization.
Methods: We reviewed billing records to identify consecutive surgical procedures for stones (shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy) performed at our county hospital between January 2011 and December 2013. Clinical outcomes, including need for temporizing measures and unplanned hospital encounters, from diagnosis to treatment were recorded.
Results: A total of 795 patients underwent surgical treatment for stones during the study period. Median time from diagnosis to surgery was 83 days (range 0–1147). A total of 292 patients underwent initial placement of a stent (196) or nephrostomy tube (96), and 47 of these required one or more tube changes prior to treatment. A total of 765 unplanned encounters (emergency department (ED) or clinic visits) were required for 440 patients (55.3%), including 11.6% who required hospital admission. Patients treated > 45 days after initial diagnosis were 12.8 times (95% CI 6.8–24.0, p < 0.001) more likely to have an unplanned clinic visit and 2.5 times (95% CI 1.8–3.6, p < 0.001) more likely to have an ED visit than patients treated within 45 days of diagnosis.
Conclusions: Longer time interval between diagnosis and treatment is associated with increased patient morbidity. Whether this is a consequence of complications of temporizing drainage or is a reflection of differences in patient acuity is currently under investigation.
Source of Funding: None
|View an interview with Justin Friedlander, one of the authors of this study.|
Presented by Justin Friedlander,1, 2 Asim Ozayar,2 Shuvro De,2 Nicholas Kavoussi,2 Jodi Antonelli,2 and Margaret Pearle2 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
1Einstein Healthcare Network, Urologic Institute of Southeastern PA, USA
2University of Texas Southwestern Medical Center, USA