SWL literature
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Bowen DK. et al., 2019: Retreatment after Ureteroscopy and Shockwave Lithotripsy: A Population-Based Comparative Effectiveness Study

Bowen DK, Song L, Faerber J, Kim J, Scales CD Jr, Tasian GE.
Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Duke Clinical Research Institute, Departments of Surgery (Urology) and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Department of Surgery, Division of Urology; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

PURPOSE:

Shockwave lithotripsy (SWL) and ureteroscopy (URS) are the most commonly performed surgeries for kidney and ureteral stones, but the comparative effectiveness of these interventions at the population level is unclear. The purpose of our study was to compare retreatment for SWL and URS.

MATERIALS AND METHODS:

A retrospective cohort study using all-payer claims data for all patients who underwent SWL or URS from 1997-2016 at 74 hospitals in South Carolina was performed. The primary outcome measure was subsequent SWL or URS within 6 months of initial surgery. Pseudorandomized trials of URS versus SWL were performed for each year, applying propensity scores to balance hospital and patient characteristics. Discrete time failure models were fit using propensity-score weighted logistic regression.

RESULTS:

Overall, 136,152 URS and SWL surgeries were performed on 95,227 unique patients with retreatment representing 9% of all surgeries. 74,251 index surgeries were SWL (59.9%) and 49,743 were URS (40.1%). SWL was associated with a 20% increased odds of retreatment (OR 1.20, 95% CI 1.13, 1.26). The probability of retreatment was 7.5% for URS and 10.4% for SWL. SWL had the greatest risk for retreatment at months 2 (OR 1.85, 95% CI 1.64, 2.10) and 3 (OR 1.76, 95% CI: 1.50, 2.06). Initial SWL patients were more likely to have SWL for retreatment (84.6%) than were patients who had initial URS to have URS (29.3%).

CONCLUSIONS:

Compared to URS, SWL was associated with increased odds of retreatment. These results have implications for shared decision-making and value-based surgical treatment of nephrolithiasis.
J Urol. 2019 Dec 20:101097JU0000000000000712. doi: 10.1097/JU.0000000000000712. [Epub ahead of print]

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Comments 1

Peter Alken on Wednesday, February 12 2020 08:30

This is the kind of important publication that turns the focus of clinical reports away from the typical “we have done so many cases“ view to the “how good was our service” view. Sophisticated statistical work is behind the data. The next change after more outcome reporting is mentioned by the authors: “The patients’ perception of the surgical experience, which is poorly understood, is extremely important. Future studies should compare outcomes identified by patients as important to their decision making and experience.“

This is the kind of important publication that turns the focus of clinical reports away from the typical “we have done so many cases“ view to the “how good was our service” view. Sophisticated statistical work is behind the data. The next change after more outcome reporting is mentioned by the authors: “The patients’ perception of the surgical experience, which is poorly understood, is extremely important. Future studies should compare outcomes identified by patients as important to their decision making and experience.“
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