1 Department of Urology, Stanford University School of Medicine, Stanford, California.
2 Division of Urology, Santa Clara Valley Medical Center, San Jose, California.
J Endourol. 2019 Feb;33(2):152-158. doi: 10.1089/end.2018.0614. Epub 2018 Nov 16.
Surgery for upper tract urinary stone disease is often reserved for symptomatic patients and those whose stone does not spontaneously pass after a trial of passage. Our objective was to determine whether payer type or race/ethnicity is associated with the timeliness of kidney stone surgery.
A population-based cohort study was conducted using the California Office of Statewide Health Planning and Development dataset from 2010 to 2012. We identified patients who were discharged from an emergency department (ED) with a stone diagnosis and who subsequently underwent a stone surgery. Primary outcome was time from ED discharge to urinary stone surgery in days. Secondary outcomes included potential harms resulting from delayed stone surgery.
Over the study period, 15,193 patients met the inclusion criteria. Median time from ED discharge to stone surgery was 28 days. On multivariable analysis patients with Medicaid, Medicare, and self-pay coverage experienced adjusted mean increases of 46%, 42%, and 60% in time to surgery, respectively, when compared with those with private insurance. In addition, patients of Black and Hispanic race/ethnicity, respectively, experienced adjusted mean increases of 36% and 20% in time to surgery relative to their White counterparts. Before a stone surgery, underinsured patients were more likely to revisit an ED three or more times, undergo two or more CT imaging studies, and receive upper urinary tract decompression.
Underinsured and minority patients are more likely to experience a longer time to stone surgery after presenting to an ED and experience potential harm from this delay.
上尿路结石病的手术通常保留给有症状的患者和那些在尝试通过后结石仍未自行排出的患者。我们的目的是确定付款人类型或种族/民族是否与肾结石手术的及时性相关。
使用加利福尼亚州全州卫生规划和发展办公室数据集，进行了一项基于人群的队列研究，时间范围为 2010 年至 2012 年。我们确定了从急诊科（ED）出院并随后接受结石手术的患者。主要结果是从 ED 出院到尿路结石手术的时间（以天为单位）。次要结果包括因延迟结石手术而导致的潜在危害。
在研究期间，15193 名患者符合纳入标准。从 ED 出院到结石手术的中位数时间为 28 天。在多变量分析中，与私人保险相比，拥有医疗补助、医疗保险和自付保险的患者手术时间分别调整后的平均增加了 46%、42%和 60%。此外，与白人患者相比，黑人和西班牙裔患者的手术时间分别调整后的平均增加了 36%和 20%。在进行结石手术之前，保险不足的患者更有可能在 ED 三次或更多次就诊、接受两次或更多次 CT 成像检查以及接受上尿路减压。
在 ED 就诊后，保险不足和少数族裔患者更有可能经历较长的结石手术时间，并可能因这种延迟而受到潜在的伤害。
