Johnston S. et al., 2022: Trends and patterns of initial percutaneous nephrolithotomy and subsequent procedures among commercially-insured US adults with urinary system stone disease: a 10-year population-based study.
Johnston S, Johnson BH, Rai P, Grange P, Amos T, Ghosh S, Buchholz N.
Epidemiology, Medical Devices, Johnson & Johnson, 410 George Street, New Brunswick, NJ, 08901, USA.
Epidemiology, Medical Devices, Johnson & Johnson, 410 George Street, New Brunswick, NJ, 08901, USA.
Medical Affairs, Ethicon, Cincinnati, OH, USA.
Health Economics and Market Access, Ethicon, Raritan, NJ, USA.
Scientific Office, U-Merge Ltd. (Urology for Emerging Countries), London, UK.
Abstract
Purpose: To describe trends and patterns of initial percutaneous nephrolithotomy (PCNL) and subsequent procedures from 2010 to 2019 among commercially-insured US adults with urinary system stone disease (USSD).
Methods: Retrospective study of administrative data from the IBM® MarketScan® Database. Eligible patients were aged 18-64 years and underwent PCNL between 1/1/2010 and 12/31/2019. Measures of interest for analysis of trends and patterns included the setting of initial PCNL (inpatient vs. outpatient), percutaneous access (1 vs. 2-step), and the incidence, time course, and type of subsequent procedures (extracorporeal shockwave lithotripsy [SWL], ureteroscopy [URS], and/or PCNL) performed up-to 3 years after initial PCNL.
Results: A total of 8,348 patients met the study eligibility criteria. During the study period, there was a substantial shift in the setting of initial PCNL, from 59.9% being inpatient in 2010 to 85.3% being outpatient by 2019 (P < 0.001). The proportion of 1 vs. 2-step initial PCNL fluctuated over time, with a low of 15.1% in 2016 and a high of 22.0% in 2019 but showed no consistent yearly trend (P = 0.137). The Kaplan-Meier estimated probability of subsequent procedures following initial PCNL was 20% at 30 days, 28% at 90 days, and 50% at 3 years, with slight fluctuations by initial PCNL year. From 2010 to 2019, the proportion of subsequent procedures accounted for by URS increased substantially (from 30.8 to 51.8%), whereas SWL decreased substantially (from 39.5 to 14.7%) (P < 0.001).
Conclusions: From 2010 to 2019, PCNL procedures largely shifted to the outpatient setting. Subsequent procedures after initial PCNL were common, with most occurring within 90 days. URS has become the most commonly-used subsequent procedure type.
World J Urol. 2022 Nov 19. doi: 10.1007/s00345-022-04210-0. Online ahead of print. PMID: 36401135
Comments 1
This article is of interest because it shows some important changes in the management of patients with urinary tract stones (usually stones > 20 mm).
The study is based on 8348 patients who were initially treated with PCNL during a ten-year period: 2010-2019.
1. Most remarkable was the shift to out-patient PCNL from 60% to 15%! Usually out-patient PCNL was carried out as a two-step procedure.
2. Within 90 days one third had repeated treatment and after 3 years ~50%.
3. URS was more commonly used than SWL
4. PCNL was used as follow-up procedure in 40% as compared with only 13% for SWL.
5. In the period 90d – 1 year: PCNL 18% and SWL 24%. In period 1-2 years: PCNL 37% and SWL 15%
Of note: whereas the economy apparently had been a driving force when changing from in-patient to out-patient PCNL, the same consideration was not made for choosing SWL as repeat stone-removing procedure.
Hans-Göran Tiselius