Wahlstedt E. et al., 2023: 120-Day ED Visits and Readmission Rates following Common Stone Procedures
Wahlstedt E, Kelly T, Jung M, Harris A.
Department of Urology, University of Kentucky, UK College of Medicine, Lexington KY.
Department of Health Economics and Outcomes Research, Becton-Dickinson, Atlanta, GA.
Department of Health Economics and Outcomes Research, Becton-Dickinson, Franklin Lakes, NJ.
Department of Urology, University of Kentucky, Medical Center, Lexington KY.
Objective: To quantify emergency department (ED) visits and hospital admissions (HA) after common urologic stone procedures including ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL) which are a concern of payors, providers, and patients.
Materials and methods: This is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement databases. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures between 2012 and 2017 were included. All-cause ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure.
Results: A total of 166,287 patients were included in the analytic cohort. For inpatient-indexed procedures, cumulative ED visits rates following stone procedure at 120 days was 18.8% for URS, 19.2% for SWL, and 23.6% for PCL. A similar trend was observed with ED visit rates, following outpatient indexed procedures at 120 days with a cumulative rate of 14.2% of SWL patients, 14.9% of URS patients, and 17.3% of PCL. A similar trend was found when examining HA. ED and HA rates increased steadily through the 120-day time period.
Conclusion: Rates of ED visits and HA following common stone procedures continue to rise at least up to 120 days following the index procedure whether in the outpatient or inpatient settings. While rates of unplanned care are similar for URS and SWL, patients undergoing PCL return to the hospital at higher rates.
Urology. 2023 Mar 15:S0090-4295(23)00211-X. doi: 10.1016/j.urology.2023.02.041. Online ahead of print. PMID: 36931570
The US have the worldwide most expensive health system. One way to cut costs is by paying for quality instead of paying for service. The data presented here provide information on the costs incurred by readmissions. They will be used in programs to reduce healthcare costs by penalizing hospitals with excessive readmissions. I was surprised by the facts that hospital readmission rates were low with only 2,9% for outpatient procedures but high - 5,5% - for inpatient procedures. Comparable figures are 4.1 % for radical prostatectomy and 5.6 % for partial nephrectomy or radical nephrectomy (1).
1 Stone BV, et al. Evaluation of Unplanned Hospital Readmissions After Major Urologic Inpatient Surgery in the Era of Accountable Care. Urology. 2017 Nov;109:94-100. doi: 10.1016/j.urology.2017.07.043. Epub 2017 Aug 8. PMID: 28801217.