Factors Influencing Postoperative Adherence after Pediatric Kidney Stone Surgery in Alabama (USA): A...

Introduction: Pediatric kidney stone disease is on the rise, and high recurrence rates necessitate consistent postoperative follow-up. Identifying social determinants of health is a key step in understanding the factors that influence adherence to follow-up after operation. This study examines socioeconomic associations with adherence after kidney stone procedure in children and evaluates whether enrollment in a multi-center clinical incentivized trial was associated with adherence. We hypothesize that those who lived farther from our hospital, lived in areas of higher deprivation, or were not enrolled in the trial were less likely to follow-up. Methods: We conducted a retrospective review of patients under 18 years old who underwent kidney stone operation from August 2019 to July 2023. Demographics, medical history, Area Deprivation Index (ADI) scores, and surgical details were analyzed. The primary outcome was follow-up clinic attendance within 16 weeks postoperation. ADI was calculated using patient home address to rank against other neighborhoods in the United States. Higher ADI score indicates more socioeconomic disadvantage. Variables were analyzed using chi-square tests for categorical variables and independent t-tests for continuous variables. Results: A total of 120 patients were identified: predominantly female (75/120, 62.5%), White (102/120, 85.0%), with median age of 15.7 years (interquartile range 11.5-17.2). Median travel distance to hospital was 51.0 miles. Of the 120 patients, 66 (55.0%) followed up within 16 weeks. Adherence was higher among patients with private insurance (p = 0.03) and lower ADI scores (less neighborhood-level deprivation) (p < 0.01). Prior surgical stone removal was also associated with lower adherence (p < 0.01). Enrollment in a clinical trial did not significantly impact imaging adherence (p = 0.98). Conclusion: Private insurance and lower ADI scores were associated with improved follow-up adherence, emphasizing the association of socioeconomic factors with adherence after kidney stone procedure. Clinical trial enrollment did not affect follow-up adherence, suggesting a need for targeted strategies to support high-risk pediatric patients.