Division of Urology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, 3 West Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA.
Department of Urology, Loyola University Medical Center, Maywood, IL, USA.
Urolithiasis. 2021 Oct;49(5):433-441. doi: 10.1007/s00240-021-01252-8. Epub 2021 Feb 17.
Our objective was to identify the rate of revisit to either emergency department (ED) or inpatient (IP) following surgical stone removal in the ambulatory setting, and to identify factors predictive of such revisits. To this end, the AHRQ HCUP ambulatory, IP, and ED databases for NY and FL from 2010 to 2014 were linked. Cases were selected by primary CPT for shock-wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL) with accompanying ICD-9 for nephrolithiasis. Cystoscopy (CYS) was selected as a comparison group. The risk of revisit was explored using multivariate models. The overall unplanned revisit rate following stone removal was 6.4% (4.2% ED and 2.2% IP). The unadjusted revisit rates for SWL, URS, and PNL are 5.9%, 6.8%, and 9.0%, respectively. The adjusted odds of revisit following SWL, URS, and PNL are 1.93, 2.25, and 2.70 times higher, respectively, than cystoscopy. The majority of revisits occurred within the first two weeks of the index procedure, and the most common reasons for revisit were due to pain or infection. Younger age, female sex, lower income, Medicare or Medicaid insurance, a higher number of chronic medical conditions, and hospital-owned surgery centers were all associated with an increased odds of any revisit. The most important conclusions were that ambulatory stone removal has a low rate of post-operative revisits to either the ED or IP, there is a higher risk of revisit following stone removal as compared to urological procedures that involve only the lower urinary tract, and demographic factors appear to have a moderate influence on the odds of revisit.
我们的目的是确定在门诊环境下接受手术碎石取石后再次前往急诊部（ED）或住院部（IP）的比率，并确定预测这种再访的因素。为此，我们对 2010 年至 2014 年期间纽约和佛罗里达州 AHRQ HCUP 门诊、住院和 ED 数据库进行了链接。通过主要 CPT 选择冲击波碎石术（SWL）、输尿管镜检查术（URS）和经皮肾镜取石术（PNL）的病例，并伴有 ICD-9 编码肾结石。选择膀胱镜检查术（CYS）作为比较组。使用多变量模型探讨了再访的风险。结石清除后未计划再访的总体发生率为 6.4%（ED 为 4.2%，IP 为 2.2%）。SWL、URS 和 PNL 的未调整再访率分别为 5.9%、6.8%和 9.0%。SWL、URS 和 PNL 后的再访调整优势比分别为 1.93、2.25 和 2.70 倍，高于膀胱镜检查术。大多数再访发生在索引手术的前两周内，再访的最常见原因是疼痛或感染。年龄较小、女性、收入较低、医疗保险或医疗补助保险、更多的慢性疾病和医院所有的手术中心都与任何再访的几率增加相关。最重要的结论是，门诊碎石术术后前往 ED 或 IP 的再访率较低，与仅涉及下尿路的泌尿外科手术相比，结石清除术后再访的风险更高，且人口统计学因素似乎对再访的几率有一定影响。
