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Unplanned 120-Day ED Visits and Readmission Rates Following Common Stone Procedures
Eric Wahlstedt1, Timothy Kelly2, Molly Jung3
1Department of Urology, University of Kentucky, UK College of Medicine, Lexington KY.
Insights
Emergency department visits and hospital admissions after urologic stone procedures like ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL) increase up to 120 days. Percutaneous nephrolithotomy (PCL) shows higher unplanned care rates compared to URS and SWL.
Area of Science:
- Urology
- Health Services Research
- Health Economics
Background:
- Urologic stone procedures are common, with emergency department (ED) visits and hospital admissions (HA) being significant concerns for healthcare stakeholders.
- Quantifying post-procedure ED visits and HA is crucial for understanding healthcare utilization and costs associated with common urologic stone treatments.
Purpose of the Study:
- To quantify emergency department (ED) visits and hospital admissions (HA) following ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL).
- To analyze trends in unplanned care up to 120 days post-procedure in both inpatient and outpatient settings.
Main Methods:
- Retrospective cohort study utilizing claims data from IBM MarketScan Commercial and Medicare Supplement databases (2012-2017).
- Inclusion of adult patients with a urologic stone diagnosis and no prior stone procedure in the preceding 12 months.
- Evaluation of all-cause ED visits and HA at 30, 60, 90, and 120-day intervals post-index procedure.
Main Results:
- A total of 166,287 patients were analyzed.
- Cumulative 120-day ED visit rates for inpatient-indexed procedures were 18.8% (URS), 19.2% (SWL), and 23.6% (PCL).
- Similar trends were observed for outpatient procedures and hospital admissions, with rates increasing steadily over the 120-day period. PCL patients had higher rates of unplanned care.
Conclusions:
- ED visits and HA rates following common urologic stone procedures escalate up to 120 days post-procedure.
- While URS and SWL demonstrate comparable rates of unplanned care, PCL is associated with significantly higher rates of return to hospital.
- These findings highlight the need for continued monitoring and management of patients undergoing urologic stone procedures.
Objective:
To quantify emergency department (ED) visits and hospital admissions (HA) after common urologic stone procedures including ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL) which are a concern of payors, providers, and patients.
Materials And Methods:
This is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement databases. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures between 2012 and 2017 were included. All-cause ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure.
Results:
A total of 166,287 patients were included in the analytic cohort. For inpatient-indexed procedures, cumulative ED visits rates following stone procedure at 120 days was 18.8% for URS, 19.2% for SWL, and 23.6% for PCL. A similar trend was observed with ED visit rates, following outpatient indexed procedures at 120 days with a cumulative rate of 14.2% of SWL patients, 14.9% of URS patients, and 17.3% of PCL. A similar trend was found when examining HA. ED and HA rates increased steadily through the 120-day time period.
Conclusion:
Rates of ED visits and HA following common stone procedures continue to rise at least up to 120 days following the index procedure whether in the outpatient or inpatient settings. While rates of unplanned care are similar for URS and SWL, patients undergoing PCL return to the hospital at higher rates.
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