1School of Medicine, University of St Andrews, St Andrews, United Kingdom.
2Mobile Medical Technology, Christchurch, New Zealand.
J Endourol. 2019 Aug;33(8):655-659. doi: 10.1089/end.2019.0122. Epub 2019 May 9.
To assess the impact of individual operator case volume on shock wave lithotripsy (SWL) treatment outcomes in more than 9000 stone cases over a 20-year period in New Zealand. Stone cases treated with SWL on the Mobile Medical Technology (MMT) vehicle between June 19, 1995, and December 1, 2014, were identified. Data collection was undertaken prospectively for patient, stone, and treatment characteristics, and retrospectively for treatment outcomes. Multivariate analysis using binary logistic regression was undertaken to assess whether radiographer stone case volume (stones/year) was an independent predictor of SWL success (stone free or clinically insignificant residual fragments ≤4 mm at follow-up). Sixteen radiographers delivered treatment to the included cohort (9039 stone cases), with a median case volume (stones/year) of 73 (range: 37-197) and median total of 425 stones treated (range: 71-1721). The two radiographers with highest case volumes achieved the highest success rates. Radiographer case volume (stones/year) was independently associated with SWL success (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.003-1.005, < 0.0001) and reduced need for post-SWL hospital admission (OR: 0.997, 95% CI: 0.994-1.000, = 0.028), but there was no associated decrease in post-SWL urosepsis (OR: 0.999, 95% CI: 0.974-1.025, = 0.941), perinephric hematoma (OR: 1.003, 95% CI: 0.985-1.020, = 0.778), or need for auxiliary procedures (OR: 1.000, 95% CI: 0.998-1.002, = 0.871). SWL success rates can be improved by increasing the frequency of cases performed by individual operators. In this multicenter cohort of more than 9000 stone cases treated over a 20-year period, the best outcomes were seen for those radiographers performing >150 cases per year.
评估超过 9000 例结石病例在 20 年期间由单个操作员病例数量对冲击波碎石术 (SWL) 治疗结果的影响。 1995 年 6 月 19 日至 2014 年 12 月 1 日期间，在移动医疗技术 (MMT) 车上接受 SWL 治疗的结石病例被确定。 对患者、结石和治疗特征进行前瞻性数据收集，并对治疗结果进行回顾性分析。 使用二元逻辑回归进行多变量分析，以评估放射技师结石病例量 (每年结石数) 是否是 SWL 成功 (结石无或临床意义上残留碎片 ≤4mm 随访)的独立预测因子。 16 名放射技师对纳入队列的患者进行了治疗 (9039 例结石病例) ，中位数病例量 (每年结石数) 为 73(范围: 37-197)，中位数总治疗结石数为 425 个 (范围: 71-1721)。 病例量最高的两位放射技师取得了最高的成功率。 放射技师病例量 (每年结石数) 与 SWL 成功率独立相关 (优势比 [OR]: 1.004，95%置信区间 [CI]: 1.003-1.005， < 0.0001) ，降低了 SWL 后住院的需要 (OR: 0.997，95% CI: 0.994-1.000， = 0.028) ，但 SWL 后尿脓毒症 (OR: 0.999，95% CI: 0.974-1.025， = 0.941) 、肾周血肿 (OR: 1.003，95% CI: 0.985-1.020， = 0.778) 或辅助治疗的需要 (OR: 1.000，95% CI: 0.998-1.002， = 0.871) 无显著相关性。 通过增加单个操作员执行的病例频率，可以提高 SWL 的成功率。 在这项超过 9000 例结石病例的多中心队列研究中，在 20 年期间，对每年执行 >150 例病例的放射技师的治疗效果最好。
