Low urologist density predicts high cost surgical treatment of stone disease.

Lack of access to urological specialists is approaching crisis levels as the number of urologists is decreasing while the demand for urological care is increasing. The financial implications of this has not been explored.

The objective of this study is to examine the impact of access and other patient factors on cost to treat urolithiasis. We hypothesized that markers of poor access would associate with higher costs of surgical encounters for patients presenting with urolithiasis.

A retrospective review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from Sept 2015 to July 2018 was conducted to investigate characteristics of surgical patients treated for urinary stone disease. Univariate analysis was performed using Welch Two Sample t-test. Multivariate analysis was performed using logistic regression. Statistical analysis was performed in R version 3.5.

When taking into account age, delayed presentation, stone size, ASA code, gender, race, income, distance, urologist density, BMI, diabetes, infection, education, language, insurance, and stone complexity, stone size > 20mm (p = 0.022; OR 2.97, CI 1.18-7.68), urologist density in the bottom quartile (p = 0.027; OR 3.22, CI 1.15-9.31), diabetes (p = 0.029; OR 3.17, CI 1.13-9.07), and infection (p=0.014; OR 3.30, CI 1.29-8.71) were the only variable statistically significant for association with top quartile of total cost.

Surgical encounter costs are largely dictated by patient clinical factors, but low regional urologist density appears to independently predict for high-cost stone surgery. Increasing patients' access to urologist may prove to be financially beneficial in longitudinal reduction in health care costs for stone disease.

Journal of endourology. 2020 Sep 30 [Epub ahead of print]

David Bayne, Manuel Armas-Phan, Sudarshan Srirangapatanam, Justin Ahn, Timothy Brown, Marshall Stoller, Thomas Chi

University of California San Francisco, Urology, 400 Parnasus Avenue, A610, San Francisco, California, United States, 94143; ., University of California San Francisco, School of Medicine, 513 Parnassus Ave, San Francisco, California, United States, 94143-0410; ., University of California San Francisco, Urology, San Francisco, California, United States; ., University of California San Francisco, Urology, San Francisco, California, United States; ., University of California Berkeley, 1438, Berkeley, California, United States; ., University of California San Francisco, Urology, San Francisco, California, United States; ., University of California San Francisco, Urology, 400 Parnassus Ave, 6th floor Urology Clinics A638, San Francisco, California, United States, 94143; .

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