Risk Factors for Adverse Outcomes Following Ureteroscopy for Stone Management in US Medicare Patients

Area of Science:

• Urology
• Nephrology
• Healthcare Management

Background:

• Ureteroscopy (URS) is a common procedure for kidney stone management.
• Identifying patients at risk for adverse outcomes post-URS is critical for improving patient safety and outcomes.
• Medicare beneficiaries represent a significant population undergoing URS, often with multiple comorbidities.

Purpose of the Study:

• To determine the prevalence of risk factors for adverse outcomes in US Medicare patients undergoing URS.
• To analyze the association between identified risk factors and adverse events such as sepsis, ICU admission, prolonged length of stay (LOS), and death.

Main Methods:

• Analysis of Medicare data for patients aged 65 and older who underwent URS between 2019 and 2023.
• Evaluation of nine specific risk factors for their prevalence and correlation with adverse events within defined timeframes (30-day and 90-day).

Main Results:

• A high proportion of patients (94.4%) had at least one risk factor, and 76.3% had two or more.
• Common risk factors included advanced age, preoperative stenting, female sex, and prior urinary tract infections.
• Patients with risk factors exhibited significantly higher rates of sepsis, ICU admission, and death compared to those without.

Conclusions:

• The majority of Medicare patients undergoing URS possess risk factors that elevate their risk of adverse outcomes.
• These findings highlight the necessity for proactive risk stratification and tailored management strategies for high-risk individuals undergoing URS.