The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefi ts, which must be placed into the context of patient preference and expected outcomes. The current state of practice refl ects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.
database to determine geographic and temporal trends along with factors affecting the likelihood of receiving opioids for urolithiasis in US EDs.METHODS: All ED visits for urolithiasis between 2006-2018 in the NHAMCS database were analyzed. Age, race, insurance status, ED provider degree, geographic region, and urban vs. rural hospital status were extracted. NHAMCS-provided survey weights were used to generate national estimates of ED prescriptions. Linear regression was used to examine overall and regional trends in opioid prescription patterns over time. Multivariate logistic regression was used to estimate factors associated with higher odds of receiving an opioid prescription.RESULTS: 14 million visits were analyzed. The proportion of visits receiving an opioid prescription for urolithiasis increased from 2006-2013, peaking in 2013 at 88.6% (Fig 1A). From 2014-2018 there was a steady decline by 3.65% per year (R2[0.86, p[0.01), nadiring at 67.80% of visits in 2017. All regions declined in opioid prescriptions except the Midwest (Fig 1B). Non-Hispanic Black race was associated with a lower chance of receiving opioid prescription (AOR[0.57, 95% CI: 0.36-0.91, p[0.02) compared to non-Hispanic Whites. Midwestern hospitals had higher odds of opioid prescriptions (AOR [2.05, 95% CI: 1.23-3.41, p[0.01) compared to the Northeast. Rural hospitals had lower odds of opioid prescriptions (AOR[0.62, 95% CI: 0.42-0.91, p[0.02) compared to urban hospitals. Gender, insurance status, and provider degree were not associated with differences in the odds of opioid prescriptions.CONCLUSIONS: Opioid prescriptions for patients with urolithiasis in US EDs have steadily declined in recent years, except in the Midwest. Non-Hispanic White race, Midwest region, and urban EDs increase the likelihood of receiving opioids. Continued efforts to encourage non-opioid alternatives for urolithiasis are essential, specifically in Midwestern cities, to reduce the disproportionate prescription of opioids.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.