Login to Access Video or Poster Abstract: MP75-03
Sources of Funding: None

Introduction

While stone treatment by ureteroscopy is increasingly performed, it incurs frequent unplanned encounters. We aim to identify avoidable predictors to minimize 30-day encounters.

Methods

We performed retrospective chart review on 157 patients who underwent ureteroscopy for urolithiasis between January and June 2016. Patient demographics, stone characteristics, operative details, and 30-day postoperative unplanned patient-initiated phone calls, emergency department (ED) visits, and readmissions were collected. Administrative patient phone calls were excluded. In order to obtain the most accurate ED and readmission rates, questionnaires were delivered to patients via telephone or email and supplemented chart review data. Fisher&[prime]s exact and Wilcoxon rank-sum tests were used for qualitative and quantitative variables, respectively.

Results

There were 44 (28%) unplanned patient-initiated phone calls, 23 (14.6%) ED visits, and 8 (5.1%) readmissions postoperatively. The most common chief complaints and ED diagnoses are listed in Table 1. Factors associated with a higher rate of phone calls include first time stone procedure (37% vs 21%, p = 0.03), outpatient status (30% vs 0%, p = 0.02), intraoperative stent placement (31% vs 0%, p = 0.01), and stent removal at home (59% vs 29%, p = 0.01). Factors associated with increased rate of ED visits were first time stone procedure (23% vs 8%, p = 0.01) and ureteral access sheath usage (30% vs 12%, p = 0.02). Factors associated with a higher rate of readmissions were bilateral procedure (20% vs 3%, p = 0.01) and ureteral access sheath usage (15% vs 3%, p = 0.03). Interestingly, of the 16 patients who had no intraoperative stenting, none had unplanned phone call, ED visit or readmission. Stone number and location, operative time, Charleston comorbidity, and history of preoperative urinary tract infection were not significantly associated with postoperative encounters.

Conclusions

Pain, first time stone treatment, and presence of a ureteral stent were common reasons for postoperative encounters after ureteroscopy. Development of a clinical care pathway for ureteroscopic stone treatment including patient education and pain management may minimize these encounters and improve treatment quality and cost.

Funding

None