Bhojani N. et al., 2022: Delays in Ureteroscopy and Shock Wave Lithotripsy After Ureteral Stent Placement: Impact on Infectious Complications, Resource Use, and Medical Costs.
Bhojani N, Paranjpe R, Cutone B, Eisner BH.
Centre Hospitalier de L'Universite de Montreal, 25443, Urology, 900 St. Denis street, Pavillon R, R08.474, Montreal, Quebec, Canada.
2Boston Scientific Corp, 5724, 300 Boston Scientific Way, Marlborough, Marlborough, Massachusetts, United States.
Boston Scientific, Marlborough, Massachusetts, United States.
Massachusetts General Hospital, Harvard Medical School, Urology, 55 Fruit Street, Dept. of Urology, GRB 1102, Boston, Massachusetts, United States.
Purpose: To evaluate the effects of ureteral stent duration prior to ureteroscopy (URS) or shockwave lithotripsy (SWL) on infectious complications, healthcare resource utilization (HCRU), and costs.
Materials and methods: Patients who underwent URS/SWL within 6-months of ureteral stent placement were identified from commercial claims, categorized by time from stent placement to URS (0-15, 16-30, 31-60, and >60 days) or SWL (0-15, 16-30, and >30 days), and followed 1-month post-procedure. The relationship between ureteral stent duration and emergency department (ED) visits, inpatient admissions, infectious complications (pyelonephritis/sepsis), imaging, and costs was evaluated.
Results: Mean time to URS (n=9,276 patients) was 21.3±24.4 days and SWL (n=4,689 patients) was 19.0±24.8 days. Compared to patients who underwent URS within 15 days of ureteral stent placement, URS 31-60 days after ureteral stent placement was significantly associated with inpatient admissions ( odds ratio [OR]: 2.56,95% confidence interval (CI): 2.03-3.22); infectious complications (OR: 2.82,95% CI: 2.09-3.81); imaging ( OR: 2.12, 95% CI: 1.82-2.46); and medical costs (OR: 1.49, 95% CI: 1.40-1.58). Compared to patients who underwent SWL within 15 days of ureteral stent placement, SWL more than 30 days after ureteral stent placement was significantly associated with ED visits (OR: 1.79, 95% CI: 1.37-2.34); inpatient admissions (OR: 3.34,95% CI: 2.38-4.69); infectious complications (OR: 3.54,95% CI: 2.20-5.70); imaging (OR: 2.65, 95% CI: 2.23-3.15); and medical costs (OR: 1.45, 95% CI: 1.36-1.54).
Conclusions: URS or SWL >30 days after ureteral stent placement increased the likelihood of infectious complications, HCRU, and medical costs.
J Endourol. 2022 Dec 2. doi: 10.1089/end.2022.0557. Online ahead of print. PMID: 36458475
Very little information is available on the effect of waiting time for active removal of ureteral stones after stenting. In that regard this article fills an important gap.
The authors analyzed consequences of waiting periods of 60 days (the latter period only for URS) after insertion of an internal stent.
The general conclusions need serious attention because with increased waiting time, infection, need of emergency visits and admission as well as repeat imaging increased significantly. So did also the cost. Details of the expenses are found in the article, but the following example may strongly support the message that early treatment with either URS or SWL is important. The cost is expressed in USD.
The results strongly support emergency treatment, for which SWL is particularly well suited. Appropriately organized it would be possible to offer SWL within a couple of days. Because URS requires more patient preparation and planning, it might be more problematic to come to early treatment at least in units with a large burden of patients.
The message: Always try to offer early treatment of patients with ureteral stones in whom stenting was the first step.