Unplanned 30-Day Encounters after Ureterorenoscopy for Urolithiasis

Kefu Du, Robert S. Wang, Joel Vetter, Alethea G. Paradis, Robert S. Figenshau, Ramakrishna Venkatesh, Alana C. Desai

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: To identify avoidable predictors of postureteroscopy (URS) unplanned encounters and to minimize 30-day encounters. Materials and Methods: We performed retrospective chart review and telephone surveys on patients who underwent URS for urolithiasis between January and June 2016. Univariate and multivariable analyses evaluated for potential predictors of unplanned encounters. Results: Of 157 patients, there were 44 (28.0%) unplanned patient-initiated clinical phone calls, 23 (14.6%) emergency department (ED) visits, and 8 (5.1%) readmissions, with pain being the most common complaint during the encounters. Factors associated with a higher rate of phone calls include first-time stone procedure (36.6% vs 20.9%, p = 0.029), outpatient status (30.3% vs 0%, p = 0.021), intraoperative stent placement (31.2% vs 0%, p = 0.006), and stent removal at home (58.8% vs 28.8%, p = 0.014). Factors associated with increased rate of ED visits were first-time stone procedure (22.5% vs 8.1%, p = 0.011) and ureteral access sheath (UAS) usage (29.6% vs 11.8%, p = 0.018). Factors associated with a higher rate of readmissions were lower body mass index (23.9 vs 29.7, p = 0.013), bilateral procedure (20.0% vs 2.9%, p = 0.010), and UAS usage (14.8% vs 3.1%, p = 0.032). Stone burden, operative time, Charlson comorbidity index, and preoperative urinary tract infection were not significantly associated with postoperative encounters. Conclusions: Pain, first-time stone treatment, presence of a ureteral stent, outpatient status, bilateral procedures, and UAS usage were common reasons for postoperative encounters after URS. Appropriate perioperative patient education and counseling and adequate pain management may minimize these encounters and improve treatment quality and patient satisfaction.

Original languageEnglish
Pages (from-to)1100-1107
Number of pages8
JournalJournal of Endourology
Volume32
Issue number12
DOIs
StatePublished - Dec 2018

Keywords

  • Renal stone
  • Stents
  • Ureteral stones
  • Ureteroscopy
  • Ureteroscopy instrumentation

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