EMERGENCY department (ED) visits and hospital admissions (HA) have continued to rise up to 120 days following stone procedures, according to a retrospective analysis on interventions such as ureteroscopy, shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL). Much of the existing literature is limited to 30-day readmission rates, but the study looked beyond this timeframe to 30, 60, 90, and 120 days.
Patients who underwent a stone procedure between 2012–17 were included in the investigation, using data from IBM® MarketScan® Commercial (Armonk, New York, USA) and Medicare Supplemental Database (Woodlawn, Maryland, USA). The cohort consisted of 166,287 adult patients who had received urologic stone diagnosis, without a history of stone procedures. In an inpatient setting, 14,349 procedures took place, and 151,938 were carried out in an outpatient setting. The results demonstrated increasing cumulative incidence of ED visits and HA up to 120 days post-procedure, with readmissions strongly correlated with genitourinary-related issues.
Cumulative 120-day ED rates after a stone surgery were 18.8% for ureteroscopy, 19.2% for SWL, and 23.6% for PCL. All-cause ED and HA were largely driven by genitourinary-related issues, accounting for 89.0% of visits at 30 days, and 81.0% at 120 days. The highest combined rates were observed in patients who underwent PCL procedures, with 30-day all-cause visits 10.0% in outpatient procedures and 12.0% inpatient. At 120 days, these rates increased to 17.0% and 23.0%, respectively. Meanwhile, the lowest all-cause rates were experienced in SWL procedures, with 3.0% outpatient and 5.0% inpatient at 30 days, followed by 6.0% and 10.0% at 120 days.
The authors urge future studies to analyse readmission past the standard 30-day cutoff to more precisely quantify the patient burden of ED visits and HA related directly to stone procedures.