Socioeconomic Disparities in the Acute Management of Stone Disease in the United States
Patients admitted to the hospital with an acute, noninfected episode of urolithiasis are candidates for medical expulsive therapy, ureteral stent placement, or upfront ureteroscopy (URS). We sought to assess socioeconomic factors influencing treatment decisions in managing urolithiasis and to determ...
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Published in | Journal of endourology Vol. 33; no. 2; p. 167 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
01.02.2019
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Abstract | Patients admitted to the hospital with an acute, noninfected episode of urolithiasis are candidates for medical expulsive therapy, ureteral stent placement, or upfront ureteroscopy (URS). We sought to assess socioeconomic factors influencing treatment decisions in managing urolithiasis and to determine differences in outcomes based on treatment modality.
The Healthcare Cost and Utilization Project State Inpatient Database, State Ambulatory Surgery and Services Database, and State Emergency Department Database for California from 2007 to 2011 and for Florida from 2009 to 2014 were utilized. Patients who were admitted to the hospital with a primary diagnosis of kidney or ureteral stone were identified. The initial treatment modality utilized was assessed and factors that influenced that decision were analyzed. Multivariate logistic regression model was fit to determine factors independently associated with upfront URS. Lastly, outcomes of noninfected patients who underwent stent alone vs URS were compared.
We identified 146,199 patients who had an inpatient admission with urolithiasis. Overall, 45% of patients had no intervention at the time of their evaluation. Of the 55% of patients who underwent surgical intervention, 42% underwent stent alone, 44% underwent upfront URS, 1% had a PCN tube placement, 8% underwent extracorporeal shockwave lithotripsy, while 5% underwent PCNL. On multivariate logistic regression model, minorities, younger patients, publicly uninsured patients, more comorbid patients, those admitted on the weekends, and those admitted to an academic institution had significantly lower odds of undergoing upfront URS. Secondary analysis demonstrated clinical and economic advantages of upfront URS vs stent alone in eligible patients.
Upfront URS is an overlooked procedure that has clinical and cost-saving implications. Unfortunately, minorities, publicly insured patients, and those admitted on the weekend are less likely to undergo upfront URS, a disparity that should be addressed by urologist. |
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AbstractList | Patients admitted to the hospital with an acute, noninfected episode of urolithiasis are candidates for medical expulsive therapy, ureteral stent placement, or upfront ureteroscopy (URS). We sought to assess socioeconomic factors influencing treatment decisions in managing urolithiasis and to determine differences in outcomes based on treatment modality.
The Healthcare Cost and Utilization Project State Inpatient Database, State Ambulatory Surgery and Services Database, and State Emergency Department Database for California from 2007 to 2011 and for Florida from 2009 to 2014 were utilized. Patients who were admitted to the hospital with a primary diagnosis of kidney or ureteral stone were identified. The initial treatment modality utilized was assessed and factors that influenced that decision were analyzed. Multivariate logistic regression model was fit to determine factors independently associated with upfront URS. Lastly, outcomes of noninfected patients who underwent stent alone vs URS were compared.
We identified 146,199 patients who had an inpatient admission with urolithiasis. Overall, 45% of patients had no intervention at the time of their evaluation. Of the 55% of patients who underwent surgical intervention, 42% underwent stent alone, 44% underwent upfront URS, 1% had a PCN tube placement, 8% underwent extracorporeal shockwave lithotripsy, while 5% underwent PCNL. On multivariate logistic regression model, minorities, younger patients, publicly uninsured patients, more comorbid patients, those admitted on the weekends, and those admitted to an academic institution had significantly lower odds of undergoing upfront URS. Secondary analysis demonstrated clinical and economic advantages of upfront URS vs stent alone in eligible patients.
Upfront URS is an overlooked procedure that has clinical and cost-saving implications. Unfortunately, minorities, publicly insured patients, and those admitted on the weekend are less likely to undergo upfront URS, a disparity that should be addressed by urologist. |
Author | Bajic, Petar Doshi, Chirag Kirshenbaum, Eric J Dornbier, Ryan Blackwell, Robert H Turk, Thomas M T Flanigan, Robert C Gupta, Gopal N Baldea, Kristin G Gorbonos, Alex |
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CitedBy_id | crossref_primary_10_1016_j_urology_2020_11_057 crossref_primary_10_1016_j_urology_2021_03_018 crossref_primary_10_1089_end_2019_0115 crossref_primary_10_1016_j_urology_2021_07_048 crossref_primary_10_1016_j_urology_2022_01_070 crossref_primary_10_1016_j_urology_2022_09_004 crossref_primary_10_1007_s11255_023_03930_5 crossref_primary_10_1016_j_urology_2020_09_025 crossref_primary_10_1016_j_jtcvs_2019_06_052 crossref_primary_10_1016_j_urology_2023_11_041 crossref_primary_10_1089_end_2022_0557 crossref_primary_10_1007_s00345_024_04768_x crossref_primary_10_1590_2175_8239_jbn_2019_0206 crossref_primary_10_1016_j_urology_2021_08_037 crossref_primary_10_1007_s00240_023_01525_4 |
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SubjectTerms | Adult Databases, Factual Emergency Service, Hospital - statistics & numerical data Female Healthcare Disparities Humans Kidney Calculi - economics Kidney Calculi - epidemiology Kidney Calculi - ethnology Kidney Calculi - therapy Lithotripsy, Laser - methods Male Middle Aged Patient Admission Socioeconomic Factors United States - epidemiology Ureteroscopy - methods |
Title | Socioeconomic Disparities in the Acute Management of Stone Disease in the United States |
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