Brooks Nathan A, Paul Charles J, Ghareeb George M, Tracy Chad R
Department of Urology, The University of Iowa , Iowa City, Iowa.
J Endourol. 2017 Feb;31(2):135-140. doi: 10.1089/end.2016.0675.
We sought to determine the rate of and factors associated with patient nonadherence to prescribed follow-up after uncomplicated ureteroscopy.
The records of 247 consecutive patients who underwent ureteroscopy at a tertiary referral center from November 2010 to February 2016 were reviewed. Bivariate and multivariate analyses were performed to determine the impact of demographic, procedural, socioeconomic, and environmental factors on the rate of compliance with secondary prevention counseling.
Forty-five patients (18.5%) were lost to scheduled follow-up for secondary prevention counseling after ureteroscopy. Lost to counseling rates were broad based and not associated with traditional predictors of poor follow-up such as age, gender, marital status, and distance traveled. On multivariate analysis, compared with those using commercial insurance, patients with Medicare (odds ratio [OR] for follow-up 0.48, 95% confidence interval [CI] 0.21, 1.1 p = 0.095) and Medicaid (OR for follow-up 0.25, 95% CI 0.1, 0.6, p < 0.001) were less likely to be adherent to prescribed follow-up.
Nearly one in five patients will be lost to follow-up for secondary prevention counseling after ureteroscopy. Lack of follow-up may prevent the diagnosis of postoperative complications and limit the ability to counsel patients on stone prevention. Efforts to improve follow-up following ureteroscopy should focus on including more postoperative counseling in the preoperative period and a more individualized approach to specific patient populations, particularly those with a lower socioeconomic status.
我们试图确定在输尿管镜检查无并发症后患者未按规定进行随访的发生率及相关因素。
回顾了2010年11月至2016年2月在一家三级转诊中心连续接受输尿管镜检查的247例患者的记录。进行了双变量和多变量分析，以确定人口统计学、手术、社会经济和环境因素对二级预防咨询依从率的影响。
45例患者（18.5%）在输尿管镜检查后未按计划进行二级预防咨询随访。失访率广泛存在，且与随访不佳的传统预测因素如年龄、性别、婚姻状况和行程距离无关。多变量分析显示，与使用商业保险的患者相比，医疗保险患者（随访的比值比[OR]为0.48，95%置信区间[CI]为0.21，1.1，p = 0.095）和医疗补助患者（随访的OR为0.25，95%CI为0.1，0.6，p < 0.001）依从规定随访的可能性较小。
输尿管镜检查后近五分之一的患者将失去二级预防咨询随访。缺乏随访可能会妨碍术后并发症的诊断，并限制对患者进行结石预防咨询的能力。改善输尿管镜检查后随访的努力应集中在术前增加更多的术后咨询，并针对特定患者群体，特别是社会经济地位较低的患者群体采取更个性化的方法。
