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Post-Operative Emergency Department Visits After Urinary Stone Surgery: Variation Based on Surgical Modality.

INTRODUCTION
Urinary stone disease is responsible for over 1 million emergency department (ED) visits annually. There is increasing regulatory and cost pressure to reduce unplanned episodes of care, particularly following elective surgery. However, the frequency of ED visits in the early post-operative period after different modalities of stone surgery is not well characterized. We aimed to describe rates of post-operative ED visits following percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shockwave lithotripsy (ESWL).


METHODS
The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) state databases for Florida (2010-2012), Iowa (2010-2012), California (2010-2011), and New York (2006-2012) were used to identify patients undergoing PCNL, URS, or ESWL. The HCUP State Emergency Department Database was used to identify post-operative ED visits in the first 30 days after surgery. Rates of post-operative ED visits were compared across surgery types with chi-square and multivariate logistic regression.


RESULTS
A total of 321,899 patients undergoing stone surgery during the study period were identified, including 151,006 (46.9%) URS, 128,040 (39.8%) ESWL, and 42,853 (13.3%) PCNL. PCNL had the highest rate of 30-day post-op ED visits (13.2%), followed by URS (10.6%) and ESWL (7.5%; p<0.0001). On multivariate logistic regression adjusting for baseline clinical and sociodemographic characteristics, PCNL (OR 1.62, 95% CI 1.56-1.69) and URS (OR 1.33, 95% CI 1.30-1.37) were both independently associated with increased risk of post-op ED visit when compared to ESWL.


CONCLUSION
Among kidney stone surgeries, PCNL has the highest rate of 30-day post-operative ED visits, while ESWL has the lowest. Post-operative ED visits are an important outcome for both patients and surgeons, and observed differences across surgical modalities should be incorporated into the pre-operative shared decision-making process.