Postoperative Emergency Department Visits After Urinary Stone Surgery: Variation Based on Surgical Modality

Urinary stone disease is responsible for more than 1 million emergency department (ED) visits annually. There is increasing regulatory and cost pressure to reduce unplanned episodes of care, particularly after elective surgery. However, the frequency of ED visits in the early postoperative period after different modalities of stone surgery is not well characterized. We aimed at describing rates of postoperative ED visits after percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shockwave lithotripsy (SWL). The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) state databases for Florida (2010-2012), Iowa (2010-2012), California (2010-2011), and New York (2006-2012) were used to identify patients undergoing PCNL, URS, or SWL. The HCUP State Emergency Department Database was used to identify postoperative ED visits in the first 30 days after surgery. Rates of postoperative ED visits were compared across surgery types with chi-square and multivariate logistic regression. A total of 321,899 patients undergoing stone surgery during the study period were identified, including 151,006 (46.9%) URS, 128,040 (39.8%) SWL, and 42,853 (13.3%) PCNL. PCNL had the highest rate of 30-day postop ED visits (13.2%), followed by URS (10.6%) and SWL (7.5%; p < 0.0001). On multivariate logistic regression adjusting for baseline clinical and sociodemographic characteristics, both PCNL (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.56-1.69) and URS (OR 1.33, 95% CI 1.30-1.37) were independently associated with increased risk of postop ED visit when compared with SWL. Among kidney stone surgeries, PCNL has the highest rate of 30-day postoperative ED visits, whereas SWL has the lowest. Postoperative ED visits are an important outcome for both patients and surgeons, and observed differences across surgical modalities should be incorporated into the preoperative shared decision-making process.