Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH.
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH; VA Outcomes Group, Veterans Health Association, VT; The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH.
Urology. 2019 Nov;133:103-108. doi: 10.1016/j.urology.2019.07.024. Epub 2019 Aug 1.
To characterize shock wave lithotripsy (SWL) utilization and assess for regional variation in the use of this procedure across the United States.
We examined SWL and URS utilization among Medicare Beneficiaries with a diagnosis of nephrolithiasis for the years 2006, 2009, and 2014. Adjusted utilization rates were calculated per 1000 beneficiaries accounting for age, sex, and race. Utilization rates were examined nationally and by hospital referral region (HRR).
A total of 511,495, 604,493, and 806,652 Medicare beneficiaries had a diagnosis of nephrolithiasis in 2006, 2009, and 2014, respectively. The adjusted rate of SWL per 1000 beneficiaries with nephrolithiasis decreased from 59.4/1000 in 2006 to 52.2/1000 and 45.5/1000 in 2009 and 2014 (13.9% decrease, P < .001). Variation was observed in SWL utilization; up to a 12-fold difference between HRRs (9.2/1000 in Winchester, VA to 105.8/1000 in Lincoln, NE). The adjusted rate of URS per 1000 beneficiaries increased by 10.2% (P < .001) between 2006 and 2014. However, the percent decrease in SWL utilization did not correlate with the percent increase in URS utilization when examined by HRR (P = .66).
Variation exists in the utilization of SWL among Medicare beneficiaries (12-fold difference). This variation is likely secondary to a series of supply, urologist, and patient-specific factors. SWL utilization decreased between 2006 and 2014, while URS increased. Stone procedure type is likely highly dependent on where patients receive their urologic care.
描述冲击波碎石术（SWL）的应用情况，并评估美国各地该手术应用的地域差异。
我们分析了 2006 年、2009 年和 2014 年接受肾结石诊断的医疗保险受益人的 SWL 和输尿管镜检查术（URS）应用情况。根据年龄、性别和种族，计算每 1000 名受益人的调整利用率。在全国范围内以及按医院转诊区（HRR）检查利用率。
2006 年、2009 年和 2014 年，分别有 511495、604493 和 806652 名医疗保险受益人被诊断为肾结石。肾结石每 1000 名受益人的 SWL 调整率从 2006 年的 59.4/1000 降至 2009 年和 2014 年的 52.2/1000 和 45.5/1000（下降 13.9%，P<.001）。SWL 的应用存在差异；HRR 之间的差异高达 12 倍（弗吉尼亚州温彻斯特的 9.2/1000 与内布拉斯加州林肯的 105.8/1000）。2006 年至 2014 年间，每 1000 名受益人的 URS 调整率增加了 10.2%（P<.001）。然而，当按 HRR 检查时，SWL 利用率下降的百分比与 URS 利用率的增加百分比没有相关性（P=0.66）。
医疗保险受益人的 SWL 应用存在差异（相差 12 倍）。这种差异可能是一系列供应、泌尿科医生和患者特定因素造成的。2006 年至 2014 年间，SWL 的利用率下降，而 URS 的利用率增加。结石处理方式很可能高度依赖于患者接受泌尿科治疗的地点。
