Department of Urology, Duke University Medical Center DUMC, 3704 Duke South Yellow Zone Room 1079, 27710, Durham, NC, USA.
Department of Urology, Duke Clinical Research Institute, Duke University Medical Center, Duke University National Clinician Scholars Program, Duke University School of Medicine, Durham, NC, USA.
Urolithiasis. 2024 Aug 6;52(1):111. doi: 10.1007/s00240-024-01608-w.
Patients with ureteral stones are often managed with a spontaneous trial of passage. While cost effective, the current literature has not examined the effects of a trial of passage on patients' work productivity. In this study, we aim to characterize work absence and productivity losses in a cohort of patients undergoing a trial of passage for ureteral stones. Actively employed patients aged 18 to 64 and discharged from Duke emergency departments without surgical intervention for ureteral stones ≤ 10 mm were contacted by phone four weeks after their presentation. Participants completed the Institute for Medical Technology Assessment Productivity Cost Questionnaire which assesses three domains: absenteeism - missed work; presenteeism -productivity when returning to work; and unpaid work - assistance with household work. Linear regression associated demographic and stone factors with productivity losses.109 patients completed the survey. In total, 67% of patients missed work, 46% had decreased productivity when returning to work, and 55% required assistance with unpaid work. 59% of patients with stones ≤ 5 mm missed work versus 84% with stones > 5 mm (p = 0.009). African American race (coefficient 23.68, 95% confidence interval 2.24-45.11, p = 0.031), first-time stone formers (coefficient 20.28, 95% confidence interval 2.50-38.07, p = 0.026), and patients with stones > 5 mm (coefficient 25.34, 95% CI 5.25-45.44, p = 0.014) were associated with increased productivity losses. The majority of patients miss work while undergoing a trial of passage and many have decreased productivity when returning to work. This information may help counsel patients in emergency departments, especially first-time stone formers, and prevent return visits.
患有输尿管结石的患者通常采用自然排石疗法进行治疗。虽然这种方法具有成本效益，但目前的文献尚未研究自然排石疗法对患者工作生产力的影响。在这项研究中，我们旨在描述接受输尿管结石自然排石疗法的患者的缺勤和生产力损失情况。在接受杜克急诊部门治疗的年龄在 18 至 64 岁之间的、因输尿管结石 ≤ 10 毫米而未接受手术干预的在职患者在就诊四周后通过电话联系。参与者完成了医疗技术评估生产力成本问卷，该问卷评估了三个领域：缺勤 - 旷工；返工时的生产力；无偿工作 - 对家务的帮助。线性回归将人口统计学和结石因素与生产力损失相关联。共有 109 名患者完成了调查。总的来说，67%的患者旷工，46%的患者返工时生产力下降，55%的患者需要无偿工作的帮助。59%的结石 ≤ 5 毫米的患者旷工，而 84%的结石 > 5 毫米的患者旷工（p = 0.009）。非裔美国人（系数 23.68，95%置信区间 2.24-45.11，p = 0.031）、首次患结石的患者（系数 20.28，95%置信区间 2.50-38.07，p = 0.026）和结石 > 5 毫米的患者（系数 25.34，95%置信区间 5.25-45.44，p = 0.014）与生产力损失增加相关。大多数患者在接受自然排石疗法时会旷工，并且许多人在返工时的生产力会下降。这些信息可能有助于在急诊部门为患者提供咨询，尤其是首次患结石的患者，从而防止再次就诊。
