National Imaging Trends after Percutaneous Nephrolithotomy.

Area of Science:

• Urology
• Radiology
• Health Services Research

Background:

• Follow-up imaging after percutaneous nephrolithotomy (PCNL) is crucial for detecting complications and residual stones.
• Optimal timing and modality for post-PCNL imaging are not well-established.
• Understanding current imaging patterns is essential for optimizing patient care.

Purpose of the Study:

• To describe national imaging use patterns following percutaneous nephrolithotomy in insured adults.
• To identify trends in imaging modality selection and timing.
• To assess demographic associations with imaging choices.

Main Methods:

• Analysis of the MarketScan® database (2007-2014) for patients aged 17-64 undergoing PCNL.
• Identification of imaging modalities (CT, ultrasound, X-ray, IVP) using CPT and ICD codes.
• Longitudinal tracking of imaging use for one year post-PCNL.
• Chi-square tests and multivariate analyses to assess demographic associations.

Main Results:

• 29% and 15% of patients had no imaging at 3 and 12 months post-PCNL, respectively.
• Abdominal X-ray was most common at 3, 6, and 12 months (46-62%).
• Nearly 50% received CT within one year, with 34% within 3 months (69% of those within 3 days).
• Renal ultrasound use increased by 13%, while CT and X-ray remained stable.
• Female gender, Northeast residence, non-HMO status, and metropolitan area were associated with higher ultrasound use.

Conclusions:

• Significant variation exists in post-PCNL imaging practices among insured adults.
• A substantial proportion of patients lack recommended follow-up imaging.
• Imaging patterns appear to be shifting, with a notable increase in renal ultrasound utilization.