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Wang HH et al, 2012: Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals

Wang HH, Huang L, Routh JC, Nelson CP
Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA


Abstract

PURPOSE: Although shock wave lithotripsy has long been considered the gold standard for treatment of kidney stones in children, ureteroscopy has become increasingly common. The factors determining procedure choice at individual centers are unclear. We sought to identify patient and hospital factors associated with the choice between shock wave lithotripsy and ureteroscopy.

MATERIALS AND METHODS: We searched the Pediatric Health Information System hospital database to identify patients with renal calculi who underwent inpatient or outpatient shock wave lithotripsy or ureteroscopy between 2000 and 2008. We used multivariate regression to evaluate whether procedure type was associated with hospital level factors, including treating hospital, region, size and teaching status, or patient level factors, including age, race, gender and insurance type.

RESULTS: We identified 3,377 children with renal stones, of whom 538 (16%) underwent surgery (shock wave lithotripsy in 48%, ureteroscopy in 52%). Procedures in 445 patients at hospitals performing both procedures were included. The relative proportion of ureteroscopy increased during the study period (24% from 2000 to 2002 vs 50% from 2006 to 2008, p=0.0001). Procedure choice was not significantly associated with patient age (p=0.2), gender (p=0.1), race (p=0.07), insurance (p=0.9), hospital size (p=0.6) or teaching status (p=0.99). Procedure choice varied significantly by geographical region (p=0.05), regional population (p=0.002) and stone location (p<0.0001). On multivariable analysis controlling for stone location, gender and treatment year the treating hospital was still highly associated with procedure choice.

CONCLUSIONS: There is wide variation in procedure choice for children with kidney stones at freestanding children's hospitals in the United States. Treatment choice depends significantly on the hospital at which a patient undergoes treatment.

Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
J Urol. 2012 Apr;187(4):1402-7. doi: 10.1016/j.juro.2011.12.010. Epub 2012 Feb 16
PMID: 22341283 [PubMed - in process]

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Comments 1

Peter Alken on Wednesday, 11 April 2012 06:39

"The probability that a given child would undergo SWL, while holding all other factors stable, varied from 7% to 93%, depending solely on the individual hospital at which the child was treated."

"...the treatment variability that we describe is unlikely to be a reflection of inherent variability in the patient population but more likely a result of the preferences, biases and experience of the physicians making these treatment decisions. Financial factors such as regional variations in reimbursement rates and physician ownership of lithotripsy equipment may influence surgical decision making"

The authors mention that this is not specific for stone treatment.

Peter Alken

"The probability that a given child would undergo SWL, while holding all other factors stable, varied from 7% to 93%, depending solely on the individual hospital at which the child was treated." "...the treatment variability that we describe is unlikely to be a reflection of inherent variability in the patient population but more likely a result of the preferences, biases and experience of the physicians making these treatment decisions. Financial factors such as regional variations in reimbursement rates and physician ownership of lithotripsy equipment may influence surgical decision making" The authors mention that this is not specific for stone treatment. Peter Alken
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