Ureteral Stent Placement Following Ureteroscopy Increases Emergency Department Visits in a Statewide Surgical Collaborative.
Identifieur interne : 000007 ( Main/Exploration ); précédent : 000006; suivant : 000008Ureteral Stent Placement Following Ureteroscopy Increases Emergency Department Visits in a Statewide Surgical Collaborative.
Auteurs : Spencer C. Hiller [États-Unis] ; Stephanie Daignault-Newton [États-Unis] ; Hector Pimentel [États-Unis] ; Sapan N. Ambani [États-Unis] ; John Ludlow [États-Unis] ; John M. Hollingsworth [États-Unis] ; Khurshid R. Ghani [États-Unis] ; Casey A. Dauw [États-Unis]Source :
- The Journal of urology [ 1527-3792 ] ; 2021.
Abstract
INTRODUCTION
Ureteral stents are commonly placed after ureteroscopy (URS). Though studies indicate that stents are associated with patient discomfort, their impact on downstream health services use is unclear. We examined patterns of stent utilization in Michigan and their association with unplanned healthcare encounters.
METHODS
We used the Michigan Urologic Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) clinical registry to identify URS cases between 2016 and 2019. Factors associated with stent placement were examined using bivariate and multivariable statistics. Using multivariable logistic regression, we evaluated whether stent placement was associated with emergency department (ED) visits and hospitalizations within 30 days.
RESULTS
We identified 9662 URS and a stent was placed in 7025 (73%) of these. Frequency of stent use across the 137 urologists varied (11-100%, p <0.001), and was not associated with total case volume. Factors associated with stent use included age and stone size. Pre-stented cases and renal stones had a decreased odds of stent placement. On multivariable analysis after adjusting for risk factors, stent placement was associated with a 1.25 higher odds of ED visit (OR 1.25; 95% CI 1.01-1.54 p=0.043) but not hospitalization (OR 1.28; 95% CI 0.94-1.76 p=0.12). In a single high-volume practice, 0.5% of cases that omit a stent required urgent stenting postoperatively.
CONCLUSION
There is substantial variation in the use of stents in Michigan, irrespective of case volume. Stent placement significantly increased the odds of an ED visit after surgery. Importantly, stent omission rarely required subsequent urgent stent placement.
DOI: 10.1097/JU.0000000000001653
PubMed: 33533636
Affiliations:
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Hiller</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Daignault Newton, Stephanie" sort="Daignault Newton, Stephanie" uniqKey="Daignault Newton S" first="Stephanie" last="Daignault-Newton">Stephanie Daignault-Newton</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Pimentel, Hector" sort="Pimentel, Hector" uniqKey="Pimentel H" first="Hector" last="Pimentel">Hector Pimentel</name><affiliation wicri:level="2"><nlm:affiliation>Spectrum Health, Grand Rapids, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Spectrum Health, Grand Rapids</wicri:cityArea></affiliation></author><author><name sortKey="Ambani, Sapan N" sort="Ambani, Sapan N" uniqKey="Ambani S" first="Sapan N" last="Ambani">Sapan N. 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Hiller</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Daignault Newton, Stephanie" sort="Daignault Newton, Stephanie" uniqKey="Daignault Newton S" first="Stephanie" last="Daignault-Newton">Stephanie Daignault-Newton</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Pimentel, Hector" sort="Pimentel, Hector" uniqKey="Pimentel H" first="Hector" last="Pimentel">Hector Pimentel</name><affiliation wicri:level="2"><nlm:affiliation>Spectrum Health, Grand Rapids, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Spectrum Health, Grand Rapids</wicri:cityArea></affiliation></author><author><name sortKey="Ambani, Sapan N" sort="Ambani, Sapan N" uniqKey="Ambani S" first="Sapan N" last="Ambani">Sapan N. Ambani</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Ludlow, John" sort="Ludlow, John" uniqKey="Ludlow J" first="John" last="Ludlow">John Ludlow</name><affiliation wicri:level="2"><nlm:affiliation>Western Michigan Urological Associates, Holland, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Western Michigan Urological Associates, Holland</wicri:cityArea></affiliation></author><author><name sortKey="Hollingsworth, John M" sort="Hollingsworth, John M" uniqKey="Hollingsworth J" first="John M" last="Hollingsworth">John M. Hollingsworth</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Ghani, Khurshid R" sort="Ghani, Khurshid R" uniqKey="Ghani K" first="Khurshid R" last="Ghani">Khurshid R. Ghani</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Dauw, Casey A" sort="Dauw, Casey A" uniqKey="Dauw C" first="Casey A" last="Dauw">Casey A. Dauw</name><affiliation wicri:level="2"><nlm:affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Urology, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author></analytic><series><title level="j">The Journal of urology</title><idno type="eISSN">1527-3792</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b></p><p>Ureteral stents are commonly placed after ureteroscopy (URS). Though studies indicate that stents are associated with patient discomfort, their impact on downstream health services use is unclear. We examined patterns of stent utilization in Michigan and their association with unplanned healthcare encounters.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We used the Michigan Urologic Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) clinical registry to identify URS cases between 2016 and 2019. Factors associated with stent placement were examined using bivariate and multivariable statistics. Using multivariable logistic regression, we evaluated whether stent placement was associated with emergency department (ED) visits and hospitalizations within 30 days.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>We identified 9662 URS and a stent was placed in 7025 (73%) of these. Frequency of stent use across the 137 urologists varied (11-100%, p <0.001), and was not associated with total case volume. Factors associated with stent use included age and stone size. Pre-stented cases and renal stones had a decreased odds of stent placement. On multivariable analysis after adjusting for risk factors, stent placement was associated with a 1.25 higher odds of ED visit (OR 1.25; 95% CI 1.01-1.54 p=0.043) but not hospitalization (OR 1.28; 95% CI 0.94-1.76 p=0.12). In a single high-volume practice, 0.5% of cases that omit a stent required urgent stenting postoperatively.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>There is substantial variation in the use of stents in Michigan, irrespective of case volume. Stent placement significantly increased the odds of an ED visit after surgery. Importantly, stent omission rarely required subsequent urgent stent placement.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33533636</PMID><DateRevised><Year>2021</Year><Month>02</Month><Day>03</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1527-3792</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Feb</Month><Day>03</Day></PubDate></JournalIssue><Title>The Journal of urology</Title><ISOAbbreviation>J Urol</ISOAbbreviation></Journal><ArticleTitle>Ureteral Stent Placement Following Ureteroscopy Increases Emergency Department Visits in a Statewide Surgical Collaborative.</ArticleTitle><Pagination><MedlinePgn>101097JU0000000000001653</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1097/JU.0000000000001653</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Ureteral stents are commonly placed after ureteroscopy (URS). Though studies indicate that stents are associated with patient discomfort, their impact on downstream health services use is unclear. We examined patterns of stent utilization in Michigan and their association with unplanned healthcare encounters.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">We used the Michigan Urologic Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) clinical registry to identify URS cases between 2016 and 2019. Factors associated with stent placement were examined using bivariate and multivariable statistics. Using multivariable logistic regression, we evaluated whether stent placement was associated with emergency department (ED) visits and hospitalizations within 30 days.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">We identified 9662 URS and a stent was placed in 7025 (73%) of these. Frequency of stent use across the 137 urologists varied (11-100%, p <0.001), and was not associated with total case volume. Factors associated with stent use included age and stone size. Pre-stented cases and renal stones had a decreased odds of stent placement. On multivariable analysis after adjusting for risk factors, stent placement was associated with a 1.25 higher odds of ED visit (OR 1.25; 95% CI 1.01-1.54 p=0.043) but not hospitalization (OR 1.28; 95% CI 0.94-1.76 p=0.12). In a single high-volume practice, 0.5% of cases that omit a stent required urgent stenting postoperatively.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">There is substantial variation in the use of stents in Michigan, irrespective of case volume. Stent placement significantly increased the odds of an ED visit after surgery. Importantly, stent omission rarely required subsequent urgent stent placement.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Hiller</LastName><ForeName>Spencer C</ForeName><Initials>SC</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Daignault-Newton</LastName><ForeName>Stephanie</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pimentel</LastName><ForeName>Hector</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Spectrum Health, Grand Rapids, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ambani</LastName><ForeName>Sapan N</ForeName><Initials>SN</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ludlow</LastName><ForeName>John</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Western Michigan Urological Associates, Holland, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hollingsworth</LastName><ForeName>John M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ghani</LastName><ForeName>Khurshid R</ForeName><Initials>KR</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dauw</LastName><ForeName>Casey A</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Department of Urology, University of Michigan, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>02</Month><Day>03</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Urol</MedlineTA><NlmUniqueID>0376374</NlmUniqueID><ISSNLinking>0022-5347</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>2</Month><Day>3</Day><Hour>12</Hour><Minute>11</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>2</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>2</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33533636</ArticleId><ArticleId IdType="doi">10.1097/JU.0000000000001653</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Michigan</li></region></list><tree><country name="États-Unis"><region name="Michigan"><name sortKey="Hiller, Spencer C" sort="Hiller, Spencer C" uniqKey="Hiller S" first="Spencer C" last="Hiller">Spencer C. Hiller</name></region><name sortKey="Ambani, Sapan N" sort="Ambani, Sapan N" uniqKey="Ambani S" first="Sapan N" last="Ambani">Sapan N. Ambani</name><name sortKey="Daignault Newton, Stephanie" sort="Daignault Newton, Stephanie" uniqKey="Daignault Newton S" first="Stephanie" last="Daignault-Newton">Stephanie Daignault-Newton</name><name sortKey="Dauw, Casey A" sort="Dauw, Casey A" uniqKey="Dauw C" first="Casey A" last="Dauw">Casey A. Dauw</name><name sortKey="Ghani, Khurshid R" sort="Ghani, Khurshid R" uniqKey="Ghani K" first="Khurshid R" last="Ghani">Khurshid R. Ghani</name><name sortKey="Hollingsworth, John M" sort="Hollingsworth, John M" uniqKey="Hollingsworth J" first="John M" last="Hollingsworth">John M. Hollingsworth</name><name sortKey="Ludlow, John" sort="Ludlow, John" uniqKey="Ludlow J" first="John" last="Ludlow">John Ludlow</name><name sortKey="Pimentel, Hector" sort="Pimentel, Hector" uniqKey="Pimentel H" first="Hector" last="Pimentel">Hector Pimentel</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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