AUA 2018: Practice Patterns and Unplanned Healthcare Encounters for Shockwave Lithotripsy in a Statewide Surgical Collaborative

San Francisco, CA ( Dr. A Leavitt, a urologist participating in the Michigan Urological Surgery Improved Collaborative (MUSIC), presented on the topic of practice patterns and unplanned healthcare encounters for Shockwave Lithotripsy (SWL). MUSIC is comprised of participants from 44 practices in the Michigan area, totalling to 250+ urologist. One of the new quality improvement initiatives of MUSIC is titled Reducing Operative Complications from Kidney Stones (ROCKS). Dr. Leavitt describes the main motivation of the study being in response to recent data suggesting that percentages of unplanned healthcare encounters after ESWL being up to 12%.

Data was collected prospectively from 8 MUSIC practices, which comprised of patients who underwent primary SWL from 8/2016 to 9/2017, totalling in a sample size of 817. The data collected included demographic information, Emergency Department (ED) visits, unplanned office visits and hospitalization within 30 days of surgery. The study also analyzed factors that affect ED visits, postoperative imaging modality, and stone free rates.

Demographic results included BMI, Positive Urine Culture, Antiplatelets, Stone Location, maximum stone diameter, ureteral stent placement, and post-op administration of Tamsulosin/Opioids. Unplanned healthcare encounters included unplanned office visits, emergency department visits and hospitalization which were 1.4%, 4.9% and 1.4% respectively. Of the total practices, the overall ED visits rate was 4.9%. Infection related reasons for ED visits were sepsis, fever/UTI, and UTI accounted for 20%, which the author discussed could be used to improve procedure to diminish infection potential. 10% of patients underwent ureteral stent placement during SWL, which the author suggest might correlate to the high percentage of patients going to the ED with hematuria and flank pain (32%). 55% of patients who received SWL returned to the ED within 0 to 4 days. Factors statistically associated with ED visits were insurance status and ureteral stent placement during SWL, however the author would conclude that with new data these factors lost significance. The stone free rate of patients who underwent SWL for renal stones versus ureteral stones were 41% and 70% respectively, which the author deemed moderate to low.

Dr. Leavitt concluded that unplanned healthcare encounter after SWL may be lower than what was previously stated. In total, ED visits after SWL were around 5% in which most patients visited the ED within 1 week of SWL. The author reiterated that ureteral stent placement during SWL is associated with ED visits. The author readdressed the low stone rates associated with SWL as being a major downside even though SWL has low complications and is minimally invasive.

Presented byDavid A Leavitt, John Hollingsworth, Tae Kim, Jaya Telang, Brian Seifman, Anna Johnson, Susan linsell, Ji Qi, Khurshid Ghani, Michigan Urological Surgery Improvement Collaborative

Written by: Luke Limfueco, UCI Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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