Shockwave Lithotripsy Use in the State of Michigan: American Urological Association Guideline Adherence and Clinical Implications

Dauw, Casey A.; Swarna, Kavya; Qi, Ji; Kim, Tae Il; Leavitt, David; Leese, Joshua; Abdelhady, Mazen; Witzke, Karla; Hollingsworth, John M.; Ghani, Khurshid R.

doi:10.1016/j.urology.2019.11.037

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…Trained abstractors prospectively record standardized data elements including patient, stone, procedural, and postoperative care data 60 days after the procedure in a web-based registry by independent chart review, as described previously. 13 Stone size is determined by the maximum diameter of the treated stone on preoperative imaging. Intraoperative complications, unplanned health care encounters within 30 days, and imaging results within 60 days of the procedure are recorded.…”

Section: Methodsmentioning

confidence: 99%

Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization

et al. 2023

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Introduction:Despite AUA guidelines providing criteria for ureteral stent omission after ureteroscopy for nephrolithiasis, stenting rates in practice remain high. Because pre-stenting may be associated with improved patient outcomes, we assessed the impact of stent omission vs placement in pre-stented and non–pre-stented patients undergoing ureteroscopy on postoperative health care utilization in Michigan.Methods:Using the MUSIC (Michigan Urological Surgery Improvement Collaborative) registry (2016-2019), we identified pre-stented and non–pre-stented patients with low comorbidity undergoing single-stage ureteroscopy for ≤1.5 cm stones with no intraoperative complications. We assessed variation in stent omission for practices/urologists with ≥5 cases. Using multivariable logistic regression, we evaluated whether stent placement in pre-stented patients was associated with emergency department visits and hospitalizations within 30 days of ureteroscopy.Results:We identified 6,266 ureteroscopies from 33 practices and 209 urologists, of which 2,244 (35.8%) were pre-stented. Pre-stented cases had higher rates of stent omission vs non–pre-stented cases (47.3% vs 26.3%). Among the 17 urology practices with ≥5 cases, stent omission rates in pre-stented patients varied widely (0%-77.8%). Among the 156 urologists with ≥5 cases, stent omission rates in pre-stented patients varied substantially (0%-100%); 34/152 (22.4%) never performed stent omission. Adjusting for risk factors, stent placement in pre-stented patients was associated with increased emergency department visits (OR 2.24, 95% CI:1.42-3.55) and hospitalizations (OR 2.19, 95% CI:1.12-4.26).Conclusions:Pre-stented patients undergoing stent omission after ureteroscopy have lower unplanned health care utilization. Stent omission is underutilized in these patients, making them an ideal group for quality improvement efforts to avoid routine stent placement after ureteroscopy.

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Section: Methodsmentioning

confidence: 99%

Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization

et al. 2023

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“…MUSIC ROCKS maintains an all-payer, prospective clinical registry containing demographic and clinical data for patients undergoing URS or shock wave lithotripsy and their 60-day postoperative outcomes. 7,8 Data abstraction is conducted at each practice by trained personnel. Data fidelity is ensured by data audits and site visits.…”

Section: Methods Data Sources and Study Populationmentioning

confidence: 99%

Improving the Quality of Upper Urinary Tract Stone Surgery: External Validation of a Statewide Collaborative’s Efforts to Reduce Emergency Department Visits After Ureteroscopy

et al. 2023

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Purpose:The ROCKS (Reducing Operative Complications from Kidney Stones) program in MUSIC (Michigan Urological Surgery Improvement Collaborative) was created to optimize ureteroscopy outcomes. Through data collection, distribution of reports, patient education, and standardization of medication, post-ureteroscopy emergency department visits in Michigan have declined. It is unclear whether this is because of statewide quality efforts or due to national trends. We therefore sought to understand emergency department visit rates in Michigan compared to a national data set.Materials and Methods:We compared the MUSIC ROCKS clinical registry in Michigan against a national cohort, Optum’s de-identified Clinformatics Data Mart, from 2016-2021 (excluding Michigan). We identified patients who underwent ureteroscopy and the proportion who had a postoperative emergency department visit within 30 days. Emergency department rates were modeled over time, adjusting for age, gender, comorbidity, and ureteral stenting.Results:We identified 24,688 patients in MUSIC ROCKS and 99,340 in the Clinformatics Data Mart database who underwent ureteroscopy. The risk-adjusted emergency department visit rate in MUSIC ROCKS significantly declined over the study period (10.5% in 2016 to 6.9% in 2021, P < 0.001) while the mean emergency department visit rate in the Clinformatics Data Mart cohort was 9.9% and did not change over time (9.6% in 2016 to 10% in 2021). Comparing emergency department visits between the cohorts, the MUSIC ROCKS rate significantly declined relative to the Clinformatics Data Mart (P < 0.001) over the study period.Conclusions:Postoperative emergency department visit rates in Michigan have declined significantly after ureteroscopy since the establishment of MUSIC ROCKS. This decline outpaced national rates, providing evidence that systematic quality initiatives can improve urological care.

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“…ROCKS maintains a clinical registry of ureteroscopy and shockwave lithotripsy procedures performed by these practices and urologists in hospitals and ambulatory surgery centers, regardless of insurance type or status. Trained abstractors prospectively and independently record standardized data elements including patient, stone, procedural and postoperative care data 60 days after the procedure in a web-based registry by chart review, as described previously [ 6 ]. Stone size is determined by maximal diameter on preoperative imaging and location is determined by report on preoperative imaging.…”

Section: Methodsmentioning

confidence: 99%

Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative

et al. 2022

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Purpose Urgent indications for nephrolithiasis treatment include obstruction with intractable pain or renal impairment without untreated infection. Patients and hospitals may benefit from urgent primary ureteroscopy. We aimed to examine variation in urgent ureteroscopy utilization and associated outcomes. Methods Using Reducing Operative Complications from Kidney Stones (ROCKS), we identified all ureteroscopy’s between 2016 and 2019. Cases were classified by acuity (elective versus urgent). We assessed practice/urologist variation in urgent ureteroscopy performance. We characterized patients demographic, operative and outcomes data, making bivariate comparisons with elective ureteroscopy to understand implications of urgent surgery. We performed multilevel modeling to understand factors associated with unplanned healthcare encounters after urgent ureteroscopy. Results 12,859 cases were identified from 33 practices and 204 urologists, 10,854 (84.4%) elective and 2005 (15.6%) urgent. Urgent ureteroscopy was performed on younger patients (53 vs 57, p < 0.001), with higher rates of ureteral stones (72.8% vs 56.8%, p < 0.001). Urgent ureteroscopy rates varied widely by practice (2–70%) and urologist (0–98%). Urgent ureteroscopy had higher stenting rates (77.4% vs 72.5%, p < 0.001), stone free rates (66% vs 58.4%, p < 0.001), and postoperative ED visits (11% vs 7.2%, p < 0.001). There were no differences in intraoperative complications or unplanned hospitalizations. Factors predictive of ED visits in urgent ureteroscopy included concomitant ureteral/renal stone location (OR = 1.53, CI = 1.05–2.23, p = 0.035). Conclusions In Michigan elective ureteroscopy is performed 5 times more frequently than urgent ureteroscopy with wide variation. Urgent ureteroscopy demonstrated low morbidity. Urgent ureteroscopy produced modestly higher stone free rates with a slightly increased frequency of unscheduled ED visits particularly for ureteral stones.

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Shockwave Lithotripsy Use in the State of Michigan: American Urological Association Guideline Adherence and Clinical Implications

Cited by 10 publications

References 22 publications

Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization

Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization

Improving the Quality of Upper Urinary Tract Stone Surgery: External Validation of a Statewide Collaborative’s Efforts to Reduce Emergency Department Visits After Ureteroscopy

Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative

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