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Srirangapatanam S. et al., 2024: Effect of core preventative screening on kidney stone surgical patterns.

Srirangapatanam S, Guan L, Baughn C, Swana HS, Bayne DB.
University of Central Florida, College of Medicine, Orlando, FL, USA. This email address is being protected from spambots. You need JavaScript enabled to view it..
University of Central Florida, College of Medicine, Orlando, FL, USA.
Department of Urology, Orlando Health, Orlando, FL, USA.
University of California, San Francisco, San Francisco, CA, USA.

Abstract

Purpose: In the surgical treatment of kidney stones, decreased access to healthcare has been shown to exacerbate stone burden, often requiring more invasive and extensive procedures. The objective of this study is to evaluate the effects of preventative health screening on kidney stone surgical treatment patterns.

Methods: We performed a retrospective analysis of data from the Healthcare Cost and Utilization Project (HCUP) Florida state-wide dataset and the PLACES Local Data for Better Health dataset from the Centers of Disease Control and Prevention (CDC). ZIP Code Tabulation Areas (ZCTAs) identified from the PLACES data were merged with the HCUP dataset to create a single dataset of community-level stone outcomes and community health measures. We included adult patients 18 years or older who underwent at least one urologic stone procedure from 2016 to 2020.

Results: 128,038 patients from 885 communities were included in the study. Patients underwent an average of 1.42 surgeries (Median = 1.39, SD = 0.16). Increased core preventative screening was associated with increased surgical frequency (Estimate: 0.51, P < 0.001). The low core preventative screening group had a higher prevalence of PNL than SWL while the high core preventative screening group had a low PNL prevalence compared to SWL.

Conclusion: Increased core preventative screenings are associated with less invasive kidney stone surgeries, suggesting that preventative screenings detect stones at an earlier stage.

Int Urol Nephrol. 2024 Feb 3. doi: 10.1007/s11255-023-03930-5. Online ahead of print.

PMID: 38308799

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Comments 1

Peter Alken on Thursday, 13 June 2024 11:00

First, they say: “Ideally, providers weigh the risks and benefits of each surgical intervention and adhere to guidelines when selecting the appropriate treatment for a patient’s kidney stone(s).”
Than they add:” In practice, however, studies have found that health insurance status influences surgical selection. Underinsured patients are less likely to receive URS as their initial intervention.”
I admit that I did not completely understand or believe in the correlation they showed and a doubt remains if causal or mere numeric, statistical correlation booster the interpretation of data.
When reading papers on population-based costs for the treatment of stones, I am always disappointed: among the many factors that have been shown to influence decision-making in medicine, I miss data
1. on the attraction of reimbursement or simply how much money goes into the pockets of decision-makers, and
2. on the quality of care offered to the population examined.
This also applies partially to the present paper and a reference (1). I remember that during the development of the German DRG-system courses were offered to learn how the clever arrangement of the treatment of an individual patient could lead to increased reimbursement. Concomitantly “Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12 % with a parallel increase in the volume of revenues of around 37 % “(2) an increase that far exceeded the increase in stone episodes in Germany. Why?
1 Kirshenbaum EJ, Doshi C, Dornbier R et al. (2019) Socioeconomic disparities in the acute management of stone disease in the United States. J Endourol 33(2):167–172
2 Bauer J, Kahlmeyer A, Stredele R, Volkmer BG. Inpatient therapy of urinary stones in Germany: development of the G-DRG system. Urologe A. 2014 Dec;53(12):1764-71. (German)

Peter Alken

First, they say: “Ideally, providers weigh the risks and benefits of each surgical intervention and adhere to guidelines when selecting the appropriate treatment for a patient’s kidney stone(s).” Than they add:” In practice, however, studies have found that health insurance status influences surgical selection. Underinsured patients are less likely to receive URS as their initial intervention.” I admit that I did not completely understand or believe in the correlation they showed and a doubt remains if causal or mere numeric, statistical correlation booster the interpretation of data. When reading papers on population-based costs for the treatment of stones, I am always disappointed: among the many factors that have been shown to influence decision-making in medicine, I miss data 1. on the attraction of reimbursement or simply how much money goes into the pockets of decision-makers, and 2. on the quality of care offered to the population examined. This also applies partially to the present paper and a reference (1). I remember that during the development of the German DRG-system courses were offered to learn how the clever arrangement of the treatment of an individual patient could lead to increased reimbursement. Concomitantly “Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12 % with a parallel increase in the volume of revenues of around 37 % “(2) an increase that far exceeded the increase in stone episodes in Germany. Why? 1 Kirshenbaum EJ, Doshi C, Dornbier R et al. (2019) Socioeconomic disparities in the acute management of stone disease in the United States. J Endourol 33(2):167–172 2 Bauer J, Kahlmeyer A, Stredele R, Volkmer BG. Inpatient therapy of urinary stones in Germany: development of the G-DRG system. Urologe A. 2014 Dec;53(12):1764-71. (German) Peter Alken
Friday, 12 July 2024