1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri.
2 Division of Urology, University of Michigan Medical School , Ann Arbor, Michigan.
J Endourol. 2018 Dec;32(12):1100-1107. doi: 10.1089/end.2018.0177. Epub 2018 Oct 18.
To identify avoidable predictors of postureteroscopy (URS) unplanned encounters and to minimize 30-day encounters.
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.
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.
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.
确定经尿道输尿管镜检查术（URS）非计划性就诊的可避免预测因素，并尽量减少 30 天内的就诊次数。
我们对 2016 年 1 月至 6 月间因尿路结石接受 URS 治疗的患者进行了回顾性图表审查和电话调查。单变量和多变量分析评估了潜在的非计划性就诊预测因素。
在 157 例患者中，有 44 例（28.0%）患者因病情需要发起了非计划性临床电话咨询，23 例（14.6%）患者去了急诊室（ED），8 例（5.1%）患者需要再次住院，其中疼痛是就诊时最常见的主诉。与电话咨询率较高相关的因素包括首次结石治疗（36.6%比 20.9%，p=0.029）、门诊状态（30.3%比 0%，p=0.021）、术中支架置入（31.2%比 0%，p=0.006）和支架在家中取出（58.8%比 28.8%，p=0.014）。与 ED 就诊率增加相关的因素包括首次结石治疗（22.5%比 8.1%，p=0.011）和输尿管鞘（UAS）使用（29.6%比 11.8%，p=0.018）。与再入院率较高相关的因素包括较低的体重指数（23.9 比 29.7，p=0.013）、双侧手术（20.0%比 2.9%，p=0.010）和 UAS 使用（14.8%比 3.1%，p=0.032）。结石负荷、手术时间、Charlson 合并症指数和术前尿路感染与术后就诊无显著相关性。
疼痛、首次结石治疗、支架留置、门诊状态、双侧手术和 UAS 使用是 URS 术后发生术后就诊的常见原因。适当的围手术期患者教育和咨询以及充分的疼痛管理可以减少这些就诊次数，提高治疗质量和患者满意度。
