TY - JOUR
T1 - Assessment of Patient and Surgical Variables Including Residency Training Level on Adverse Events after Ureteroscopy for Ureteral Stones
T2 - A Multivariate Analysis
AU - Johans, Carrie
AU - Smelser, Woodson
AU - Deroche, Chelsea
AU - Campbell, Jack
AU - Cummings, James
N1 - Publisher Copyright:
© Copyright 2018, Mary Ann Liebert, Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Purpose: With advances in technology, ureteroscopy (URS) is increasingly utilized for the management of urolithiasis. Previous studies have attempted to characterize the post-operative complication and readmission rates relative to the technical difficulty of the procedure. There is limited data exploring the resident level of training and its effect on adverse outcomes in these cases. We review our experience with URS to create a model to predict factors, including resident experience, that affect rates of post-operative complications. Materials and Methods: We reviewed ureteroscopies performed at our academic facility from January 2009 to December 2013. Ureteral-only stones were examined for demographics, stone characteristics, operative techniques, and resident training level. Post-operative adverse events requiring urology consultation, clinic or emergency department visits, hospital admission, prolonged post-operative hospitalization, or unplanned repeat surgery within 30 days of the procedure were identified and analyzed. Results: Four hundred seventeen cases of URS for ureteral-only stones were included for study. We identified 53 (12.7%) involving an unexpected post-operative course. Several logistic regression models were created to make a predictive model of adverse events. One model found only lack of stone clearance to be significant for increasing the likelihood of an adverse event. A second model determined that no residency year showed higher odds of adverse outcomes. Conclusions: URS has increased in prevalence in recent years, but overall complication rates are low. Resident level of experience does not appear to impact adverse event rate. Stone clearance during initial surgery appears to be the most important in avoiding adverse events. Further expansion of the database over time will improve our ability to predict adverse outcomes in this common procedure.
AB - Purpose: With advances in technology, ureteroscopy (URS) is increasingly utilized for the management of urolithiasis. Previous studies have attempted to characterize the post-operative complication and readmission rates relative to the technical difficulty of the procedure. There is limited data exploring the resident level of training and its effect on adverse outcomes in these cases. We review our experience with URS to create a model to predict factors, including resident experience, that affect rates of post-operative complications. Materials and Methods: We reviewed ureteroscopies performed at our academic facility from January 2009 to December 2013. Ureteral-only stones were examined for demographics, stone characteristics, operative techniques, and resident training level. Post-operative adverse events requiring urology consultation, clinic or emergency department visits, hospital admission, prolonged post-operative hospitalization, or unplanned repeat surgery within 30 days of the procedure were identified and analyzed. Results: Four hundred seventeen cases of URS for ureteral-only stones were included for study. We identified 53 (12.7%) involving an unexpected post-operative course. Several logistic regression models were created to make a predictive model of adverse events. One model found only lack of stone clearance to be significant for increasing the likelihood of an adverse event. A second model determined that no residency year showed higher odds of adverse outcomes. Conclusions: URS has increased in prevalence in recent years, but overall complication rates are low. Resident level of experience does not appear to impact adverse event rate. Stone clearance during initial surgery appears to be the most important in avoiding adverse events. Further expansion of the database over time will improve our ability to predict adverse outcomes in this common procedure.
KW - Nephrolithiasis
KW - Outcomes
KW - Renal calculi
KW - Ureter
KW - Ureteroscopy
UR - http://www.scopus.com/inward/record.url?scp=85042121170&partnerID=8YFLogxK
U2 - 10.1089/end.2017.0757
DO - 10.1089/end.2017.0757
M3 - Article
C2 - 29212367
AN - SCOPUS:85042121170
SN - 0892-7790
VL - 32
SP - 144
EP - 147
JO - Journal of Endourology
JF - Journal of Endourology
IS - 2
ER -