Stout M. et al., 2025: Predictors of follow-up of pediatric stone patients after surgical intervention.

Megan Stout 1, Alyssa Lombardo 1, Nora Thompson 2, Jason Benedict 3, Seth Alpert 4, Daniel DaJusta 4, Molly Fuchs 4, Rama Jayanthi 4, Daryl Mcleod 4, Christina B Ching 5
1The Ohio State Wexner Medical Center: Department of Urology, Columbus OH, USA; The Ohio State University College of Medicine, Columbus OH, USA.
2Clinical Research Services, Nationwide Children's Hospital, Columbus OH, USA; Kidney and Urinary Tract Center, Abigail Wexner Resesarch Institute at Nationwide Children's Hospital, Columbus OH, USA; Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA.
3Center for Biostatistics, The Ohio State University, Columbus OH, USA.
4Kidney and Urinary Tract Center, Abigail Wexner Resesarch Institute at Nationwide Children's Hospital, Columbus OH, USA; Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA.
5Kidney and Urinary Tract Center, Abigail Wexner Resesarch Institute at Nationwide Children's Hospital, Columbus OH, USA; Department of Pediatric Urology, Nationwide Children's Hospital, Columbus OH, USA.

Abstract

Objective: We investigated if socioeconomic and demographic factors predict post-surgical follow-up in pediatric stone patients.

Materials and methods: All patients having kidney stone surgery at a single academic pediatric hospital over a 5 year period (2016-2020) were identified through the use of CPT® codes specific to ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. Electronic charts were reviewed for patient demographics, stone characteristics, and characteristics of intervention. Unique patients with a scheduled post-operative follow-up office visit following a first time stone surgery were included in the patient cohort (Figure 1). Primary outcome was attendance of a scheduled provider visit within 6 months after surgery. Secondary outcomes included completion of scheduled post-operative imaging and 24-h urine study. Univariable analysis was performed.

Results: 195 pediatric patients, a median age of 15.4 years (IQR: 11.34, 17.14) at surgery, were identified. The majority were non-Hispanic white (86.2%) and female (62.1%). Most had undergone ureteroscopy alone (85.6%). Of the 195 patients, 146 (74.9%) attended a post-operative office visit. Indicators of lower socioeconomic status, such as having public insurance and being from a single-parent home, were associated with not attending a scheduled follow-up visit (p < 0.01 and p = 0.02, respectively). Patients with a pre-operative urology clinic visit were more likely to follow-up with a clinic visit (p = 0.02), while those with a larger total stone burden treated were more likely to undergo ordered imaging (p < 0.01).

Discussion: We found that indicators of lower socioeconomic status, such as having public insurance status and being in a single-parent household, were associated with lower pediatric follow-up compliance after kidney stone surgery, while patients seen in the urology clinic preoperatively were more likely to attend follow-up.

Conclusion: Identifying factors that may predict non-compliance could be used to help at-risk patient populations.

J Pediatr Urol. 2025 Feb;21(1):23-28. doi: 10.1016/j.jpurol.2024.09.003. Epub 2024 Sep 7.
PMID: 39406668