Department of Urology, University of Michigan, Ann Arbor, Michigan.
Spectrum Health, Grand Rapids, Michigan.
J Urol. 2021 Jun;205(6):1710-1717. doi: 10.1097/JU.0000000000001653. Epub 2021 Feb 3.
Ureteral stents are commonly placed after ureteroscopy. Although studies indicate that stents are associated with patient discomfort, their impact on downstream health services use is unclear. We examined patterns of stent utilization in Michigan and their association with unplanned health care encounters.
We used the Michigan Urological Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) clinical registry to identify ureteroscopy cases between 2016 and 2019. Factors associated with stent placement were examined using bivariate and multivariable statistics. Using multivariable logistic regression, we evaluated whether stent placement was associated with emergency department visits and hospitalizations within 30 days.
We identified 9,662 ureteroscopies and a stent was placed in 7,025 (73%) of these. Frequency of stent use across the 137 urologists varied (11%-100%, p <0.001) and was not associated with total case volume. Factors associated with stent use included age and stone size. Pre-stented cases and renal stones had a decreased odds of stent placement. On multivariable analysis after adjusting for risk factors, stent placement was associated with a 1.25 higher odds of emergency department visit (OR 1.25, 95% CI 1.01-1.54, p=0.043) but not hospitalization (OR 1.28, 95% CI 0.94-1.76, p=0.12). In a single high volume practice, 0.5% of cases that omitted a stent required urgent stenting postoperatively.
There is substantial variation in the use of stents in Michigan, irrespective of case volume. Stent placement significantly increased the odds of an emergency department visit after surgery. Importantly, stent omission rarely required subsequent urgent stent placement.
输尿管镜检查后通常会放置输尿管支架。尽管研究表明支架会引起患者不适，但它们对下游卫生服务利用的影响尚不清楚。我们检查了密歇根州支架使用的模式及其与非计划性医疗保健的关系。
我们使用密歇根州泌尿外科手术改进合作组织的“减少肾结石手术并发症”（MUSIC ROCKS）临床登记处，确定 2016 年至 2019 年期间的输尿管镜检查病例。使用双变量和多变量统计学方法检查支架放置的相关因素。我们使用多变量逻辑回归评估支架放置是否与术后 30 天内急诊就诊和住院有关。
我们确定了 9662 例输尿管镜检查，其中 7025 例（73%）放置了支架。137 位泌尿科医生的支架使用频率（11%-100%，p<0.001）各不相同，与总病例量无关。与支架使用相关的因素包括年龄和结石大小。预置支架的病例和肾结石的支架放置率降低。在多变量分析中，调整了危险因素后，支架放置与急诊就诊的几率增加 1.25 倍（比值比 1.25，95%置信区间 1.01-1.54，p=0.043），但与住院无关（比值比 1.28，95%置信区间 0.94-1.76，p=0.12）。在一家高容量实践中，0.5%省略支架的病例术后需要紧急支架置入。
密歇根州支架的使用存在很大差异，与病例量无关。支架放置显著增加了术后急诊就诊的几率。重要的是，支架遗漏很少需要随后进行紧急支架置入。
