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Predictors of follow-up of pediatric stone patients after surgical intervention
Megan Stout1, Alyssa Lombardo1, Nora Thompson2
1The Ohio State Wexner Medical Center: Department of Urology, Columbus OH, USA; The Ohio State University College of Medicine, Columbus OH, USA.
Insights
Socioeconomic factors like public insurance and single-parent homes predict lower follow-up rates in pediatric kidney stone surgery patients. Early urology clinic visits improve compliance, aiding at-risk populations.
Area of Science:
- Pediatric Urology
- Health Services Research
- Health Equity
Background:
- Post-surgical follow-up is crucial for pediatric stone patients.
- Understanding factors influencing follow-up compliance is essential for optimizing care.
Purpose of the Study:
- To investigate the association between socioeconomic and demographic factors and post-surgical follow-up in pediatric kidney stone patients.
- To identify predictors of follow-up compliance after surgical intervention for pediatric urolithiasis.
Main Methods:
- Retrospective review of 195 pediatric patients undergoing kidney stone surgery (2016-2020).
- Analysis of CPT® codes for ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy.
- Evaluation of patient demographics, stone characteristics, and post-operative visit attendance within 6 months.
Main Results:
- 74.9% of patients attended scheduled post-operative visits.
- Lower socioeconomic indicators (public insurance, single-parent home) were linked to lower follow-up attendance (p < 0.01, p = 0.02).
- Pre-operative urology clinic visits (p = 0.02) and higher stone burden (p < 0.01) predicted better follow-up and imaging completion, respectively.
Conclusions:
- Socioeconomic status significantly impacts pediatric post-kidney stone surgery follow-up compliance.
- Targeted interventions for at-risk populations, informed by predictive factors, can improve adherence to care plans.
- Pre-operative engagement with urology services is a positive predictor for post-operative follow-up.
Objective:
We investigated if socioeconomic and demographic factors predict post-surgical follow-up in pediatric stone patients.
Materials And Methods:
All patients having kidney stone surgery at a single academic pediatric hospital over a 5 year period (2016-2020) were identified through the use of CPT® codes specific to ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. Electronic charts were reviewed for patient demographics, stone characteristics, and characteristics of intervention. Unique patients with a scheduled post-operative follow-up office visit following a first time stone surgery were included in the patient cohort (Figure 1). Primary outcome was attendance of a scheduled provider visit within 6 months after surgery. Secondary outcomes included completion of scheduled post-operative imaging and 24-h urine study. Univariable analysis was performed.
Results:
195 pediatric patients, a median age of 15.4 years (IQR: 11.34, 17.14) at surgery, were identified. The majority were non-Hispanic white (86.2%) and female (62.1%). Most had undergone ureteroscopy alone (85.6%). Of the 195 patients, 146 (74.9%) attended a post-operative office visit. Indicators of lower socioeconomic status, such as having public insurance and being from a single-parent home, were associated with not attending a scheduled follow-up visit (p < 0.01 and p = 0.02, respectively). Patients with a pre-operative urology clinic visit were more likely to follow-up with a clinic visit (p = 0.02), while those with a larger total stone burden treated were more likely to undergo ordered imaging (p < 0.01).
Discussion:
We found that indicators of lower socioeconomic status, such as having public insurance status and being in a single-parent household, were associated with lower pediatric follow-up compliance after kidney stone surgery, while patients seen in the urology clinic preoperatively were more likely to attend follow-up.
Conclusion:
Identifying factors that may predict non-compliance could be used to help at-risk patient populations.
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