Login to Access Video or Poster Abstract: MP75-02
Sources of Funding: none

Introduction

Ureteroscopy is one of the most common ambulatory procedures performed by urologists to manage a variety of different pathologies, including nephrolithiasis and urothelial cancers. As a high volume endourologic center, the vast majority of our emergency department visits occur after ureteroscopy. The affordable care act and centers for Medicare and Medicaid services have recently instituted several quality improvement initiatives, one of which includes decreased hospital reimbursement for re-admissions within 30 days. We attempted to identify trends surrounding outpatient ureteroscopy in hopes of decreasing future ED visits._x000D_

Methods

A retrospective chart review from 7/1/2015 to 12/31/2015 was performed to identify patients who returned to the ED within 30 days of elective ureteroscopy. CPT codes 52351-6 and 52344-6 were used as search parameters. Patient demographics, operative characteristics, and ED presentation data were collected and analyzed. _x000D_

Results

A total of 330 ureteroscopies were performed, resulting in 47 ED visits (14.2%) occurring an average of 8.4 days [1–28] postoperatively. 29 were female and 18 male with an average age of 48.2 [16-86]. 27 (57.4%) were pre-stented an average of 11.5 days preoperatively. All patients were discharged with a stent in place, and 26 (55.3%) with a string attached with instructions to remove at home. 40 (85.1%) were discharged with either Tylenol#3 or Tramadol for pain control. The most common presenting complaint was flank pain (59.6%). Of these patients, 13 (46.4%) presented after the stent was self-pulled, 3 (10.7%) presented after the stent was inadvertently removed, 4 (14.3%) after it was removed via cystoscopy in clinic, and 8 (28.6%) with the stent in place._x000D_

Conclusions

The rate of ED visits following ureteroscopy is estimated to be from 5% to 16%. Our results were in line with previous data demonstrating pain as the most common presenting complaint in the ED following ambulatory surgery. The cause of the pain may be due to issues with self-removal of stents and inadequate postoperative pain management. Some evidence exists that pre-stenting improves stone free rates, which intuitively would lead to decreased ED visits. However, this was not the case in our data as a majority of patients had been pre-stented. This hypothesis-generating study elicits the need to explore potential methods, including improved pain management and expectations, particularly with self-pulled stents, in order to possibly decrease ED visit rates._x000D_

Funding

none