Johans Carrie, Smelser Woodson, DeRoche Chelsea, Campbell Jack, Cummings James
Department of General Surgery, Division of Urology, University of Missouri , Columbia, Missouri.
J Endourol. 2018 Feb;32(2):144-147. doi: 10.1089/end.2017.0757. Epub 2018 Jan 10.
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.
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.
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.
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.
随着技术的进步，输尿管镜检查（URS）越来越多地用于治疗尿路结石。先前的研究试图根据手术的技术难度来描述术后并发症和再入院率。探索住院医师培训水平及其对这些病例不良结局影响的数据有限。我们回顾了我们在输尿管镜检查方面的经验，以建立一个模型来预测影响术后并发症发生率的因素，包括住院医师经验。
我们回顾了2009年1月至2013年12月在我们学术机构进行的输尿管镜检查。仅对输尿管结石患者的人口统计学、结石特征、手术技术和住院医师培训水平进行了检查。确定并分析了术后需要泌尿外科会诊、门诊或急诊科就诊、住院、术后住院时间延长或在手术后30天内进行计划外再次手术的不良事件。
纳入417例仅输尿管结石的输尿管镜检查病例进行研究。我们发现53例（12.7%）涉及意外的术后病程。创建了几个逻辑回归模型来建立不良事件的预测模型。一个模型发现只有结石清除不完全对增加不良事件的可能性有显著影响。第二个模型确定没有哪个住院年份显示出更高的不良结局几率。
近年来输尿管镜检查的普及率有所提高，但总体并发症发生率较低。住院医师的经验水平似乎不会影响不良事件发生率。初次手术时的结石清除似乎是避免不良事件最重要的因素。随着时间的推移进一步扩大数据库将提高我们预测这一常见手术不良结局的能力。
