Qin Wang et al., 2024: urgical procedure and recurrence of upper urinary tract stone: a national-wide study based on hospitalized patients
Qin Wang, Yu Wang, Chao Yang, Jinwei Wang, Xiao-Chun Zhang, Luxia Zhang, Ming-Hui Zhao
Renal Division, Department of Medicine, Institute of Nephrology, Peking University First Hospital, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Renal Division, Department of Medicine, Institute of Nephrology, Peking University First Hospital, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Advanced Institute of Information Technology, Peking University, Hangzhou, Zhejiang, China.
Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
National Institute of Health Data Science at Peking University, Beijing, China.
Peking-Tsinghua Center for Life Sciences, Beijing, China.
Abstract
Purpose: This study aimed to investigate the influence of surgical intervention on recurrence risk of upper urinary tract stone and compare the medical burden of various surgical procedures.
Methods: This study analyzed data from patients with upper urinary tract stone extracted from a national database of hospitalized patients in China, from January 2013 to December 2018. Surgical recurrence was defined as patients experience surgical procedures for upper urinary tract stone again with a time interval over 90 days. Associations of surgical procedures with surgical recurrence were evaluated by Cox regression.
Results: In total, 556,217 patients with upper urinary tract stone were included in the present analysis. The mean age of the population was 49.9 ± 13.1 years and 64.1% were men. During a median follow-up of 2.7 years (IQR 1.5-4.0 years), 23,012 patients (4.1%) had surgical recurrence with an incidence rate of 14.9 per 1000 person-years. Compared to patients receiving open surgery, ESWL (HR, 1.59; 95% CI 1.49-1.70), URS (HR, 1.38; 95% CI 1.31-1.45), and PCNL (HR, 1.11; 95% CI 1.06-1.18) showed a greater risk for surgical recurrence. Patients receiving ESWL had the shortest hospital stay length and the lowest cost among the 4 procedures.
Conclusions: Compared with open surgery, ESWL, URS, and PCNL are associated with higher risks of surgical recurrence for upper urinary tract stone, while ESWL showed the least medical burden including both expenditure and hospital stay length. How to keep balance of intervention efficacy and medical expenditure is an important issue to be weighed cautiously in clinic practice and studied more in the future.
World J Urol. 2024 Mar 13;42(1):132. doi: 10.1007/s00345-024-04831-7. PMID: 38478095
DOI: 10.1007/s00345-024-04831-7
Comments 1
The figures alone mean that this report will go down in the urological literature.
The driving forces and stories behind data like these - from whatever country! - are impossible to know. A few years ago, I have read in a German weekly that 96 per cent of the Chinese medical doctors are dissatisfied with their salaries; on average, a doctor only earned around 19 per cent more than a worker what gave rise to many opportunities for corruption. Money is definitively also a driving force in western health systems with hospitals running into economic problems while trying to make money.
Figures that surprised me were
• the high frequency of open surgery
• the differences between rural and urban areas
• the long hospital stays and
• the increase in "expenditure per hospitalisation" for the second procedure compared to the first, in particular the more than doubled figure for ESWL, which is still the cheapest one.
Peter Alken