Emily C Serrell et al., 2024: Surgical Stone Trends from 2013 to 2021 in the US Medicare Population: Before and After the COVID-19 Pandemic
Emily C Serrell 1 , Ali Antar 2 , Eric Buinevicius 3 , Shuang Li 4 , Christopher Haas 5 , Margaret Knoedler 6 , Daniel Gralnek 7 , Kristina L Penniston 8 , Stephen Y Nakada 9
1Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
2Department of Urology, Tufts Medical Center, Medford, Massachusetts, USA.
Abstract
Introduction and Objective: In early 2020, as the SARS-Cov-2 (COVID-19) pandemic progressed, many institutions limited nonurgent surgical care. This coincided with a decade-long trend of increasing percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) and decreasing shock wave lithotripsy (SWL) for surgical management of urolithiasis. Herein, we evaluate temporal stone surgery rates and surgeon volumes in the Medicare population and suggest how COVID-19 contributed to them. Methods: Retrospective analysis was conducted using the "Medicare Physician & Other Practitioners" database containing data from January 2013 to December 2021. Adult patients who underwent stone surgery were included. We evaluated surgeon characteristics and changes in case volumes over time adjusted for population. Results: In 2013, urologists performed 68,910 stone surgeries: SWL 42,903 (62%); URS 25,321 (37%); PCNL 686 (1%). Over the next 8 years, there was an average annual increase in URS (+13%) and PCNL (+13%) and decrease in SWL (-2%). In 2020, there was a 14% reduction in all stone cases: SWL (-25%); URS (-6%); PCNL (-8%). By 2021, case volumes recovered to pre-2020 levels, though SWL remained low: SWL 33,974 (34%); URS 64,541 (64%); PCNL 1764 (2%). From 2013 to 2021, the number of urologists performing SWL decreased (1718 to 1361) while URS and PCNL providers doubled (1,347 to 2,914 and 28 to 76, respectively). Conclusions: From 2013 to 2021, there was an increase in URS and PCNL and a decrease in SWL in the US Medicare population. The COVID-19 pandemic was associated with a decline in stone surgeries, particularly SWL. By 2021, PCNL and URS case numbers increased significantly with a smaller increase in SWL.
J Endourol. 2024 Jun 14. doi: 10.1089/end.2024.0063. Online ahead of print. PMID: 38874511
Comments 1
This is an epidemiological report based on data extraction from “Medicare Physicians & Other Practitioners Database”. The text is filled with numbers and percentages regarding URS, PCNL and SWL, during the eight-year period 2013-2021, thus including the covid pandemic. The message is not particularly exciting and not easy to grasp. Neither is reading of the text despite some famous authors.
Below I have tried to summarize the most important information:
It should be noted that between 2019 and 2020 SWL decreased by 25%. It is surprising that SWL was not more commonly used during the pandemic. However, the explanation is probably that SWL in USA regularly is carried out with anesthesia and thus SWL is not an anesthesia-free method with the benefit of avoiding aerosol spreading of virus.
One interesting point was that numerous urologists dropped out of the system during the pandemic!
Those readers who are particularly interested in this kind of information should read the article, but the content might be of limited interest for others than American urologists.
Hans-Göran Tiselius