Department of Urology, Yale-New Haven Hospital, New Haven, Connecticut.
J Endourol. 2019 Oct;33(10):858-862. doi: 10.1089/end.2019.0382. Epub 2019 Sep 25.
Ureteral stents are utilized in the management of many urologic conditions including nephrolithiasis, ureteral strictures, ureteral injuries, and malignant obstruction. Prolonged placement has a risk of stent failure with obstruction, infection, and encrustation. We describe the novel use of the Epic electronic medical record (EMR) platform to identify patients lost to follow-up after ureteral stent placement. We additionally identified risk factors for lost stents. A methodology was created in Epic to log ureteral stent insertion and removal, with automated reporting of stents implanted for >90 days. Starting in January 2015, a nurse reviewed the reports monthly and contacted lost patients to arrange follow-up. We retrospectively reviewed patient charts for clinical characteristics including age, gender, race, surgical urgency (elective emergent), and insurance status to identify risk of failure to follow-up. We identified 1788 patients who underwent ureteral stent placement over the study period. Sixteen patients (0.9%) failed to follow-up for ureteral stent explantation. Using multivariate logistic regression, stents placed in an emergent setting (odds ratio [OR] 3.5, = 0.018) and black race (OR 4.03, = 0.018) were independent predictors of failure to follow-up. Age, gender, and insurance status were not predictors of follow-up. On average, explanted stents were in place for 15 days 165 days among those patients lost to follow-up. Lost ureteral stents are rare, however, potentially high impact events. Automated data collected through an EMR such as Epic facilitates easy identification of these events before potential complications. Stents placed in an emergent setting are at a higher risk of poor follow-up as they may not be readily connected in the health care system or misunderstand discharge instructions, creating barriers to follow-up. Black race is an independent predictor of a stent being retained and is of uncertain etiology, which will require further investigation to clarify.
输尿管支架用于治疗多种泌尿科疾病，包括肾结石、输尿管狭窄、输尿管损伤和恶性梗阻。长期留置支架有发生支架堵塞、感染和结石形成的风险。我们描述了一种利用 Epic 电子病历（EMR）平台识别输尿管支架置入后失访患者的新方法。此外，我们还确定了支架丢失的危险因素。在 Epic 中创建了一种方法来记录输尿管支架的插入和取出，并自动报告植入>90 天的支架。从 2015 年 1 月开始，一名护士每月审查报告，并联系失访患者安排随访。我们回顾性地审查了患者的病历，以确定临床特征，包括年龄、性别、种族、手术紧迫性（择期或紧急）和保险状况，以确定随访失败的风险。我们确定了在研究期间接受输尿管支架置入术的 1788 名患者。16 名患者（0.9%）未能接受输尿管支架取出随访。使用多变量逻辑回归，紧急情况下放置的支架（比值比[OR]3.5，=0.018）和黑人种族（OR 4.03，=0.018）是随访失败的独立预测因素。年龄、性别和保险状况不是随访的预测因素。在平均 15 天至 165 天的时间内，失访患者的支架被取出。丢失的输尿管支架很少见，但可能会产生严重影响。通过 EMR（如 Epic）自动收集的数据可以在潜在并发症发生之前轻松识别这些事件。紧急情况下放置的支架更有可能出现不良随访，因为它们可能无法在医疗保健系统中迅速连接，或者对出院指示的理解有误，从而导致随访障碍。黑人种族是支架保留的独立预测因素，其病因尚不清楚，需要进一步研究以澄清。
