Postoperative Emergency Department Visits After Urinary Stone Surgery: Variation Based on Surgical Modality

Khanna, Abhinav; Fedrigon, Donald; Monga, Manoj; Gao, Tianming; Schold, Jesse D.; Abouassaly, Robert

doi:10.1089/end.2019.0399

Cited by 9 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 11 – 14 The primary outcome of postprocedural ED visits represents an important health care economic burden and an outcome associated with the quality of treatment. 15 – 17 Theoretically, interventions that improve the quality of care should result in a decreased ADE incidence and reduced ED visits and formed the basis of our hypothesis that the MAPPP app would be effective in reducing ED visits during the 30-day postprocedural period. Emergency department visits were decreased by approximately 50% in the acceptance group versus the rejection group (4.0% vs 8.3%, P = .0205).…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Spyropoulos

Giannis

Cohen

et al. 2020

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Appropriate perioperative management of patients on chronic oral anticoagulation (OAC)—including warfarin and the direct oral anticoagulants—is a poorly defined yet important clinical issue with potentially severe consequences in the postoperative period. We sought to prospectively evaluate the effect of the Management of Anticoagulation in the Periprocedural Period (MAPPP) mobile app as a clinical decision tool in the management of patients on chronic OAC undergoing elective procedures or surgeries. Between January 1, 2018, and January 31, 2019, 642 patients treated in our health system were included. Eligible patients met the following criteria: age >18 years old, creatinine clearance ≥15 mL/min, and on chronic OAC with adequate information regarding baseline characteristics. Our study outcome was patient’s emergency department (ED) visits within 30 days postprocedure. The MAPPP app was integrated into the electronic health record (EHR), and the end user was free to accept or decline recommended evidence-based perioperative anticoagulation management guidance. Analysis revealed that acceptance was more common in younger patients ( P = .0137), patients on oral anticoagulants other than warfarin ( P < .0001), and patients undergoing increased bleeding risk procedures ( P = .0068). Acceptance of the MAPPP app recommendation was significantly associated with fewer ED visits (acceptance group: 4.0% vs rejection group: 8.3%, P = .0205). Logistic regression showed that intervention acceptance and female gender were significantly associated with fewer—while age ≥80 with more—30-day ED visits. Our findings indicate that newer technologies, such as the MAPPP app, integrated into clinical EHR workflow, can significantly augment evidence-based perioperative anticoagulation management and potentially result in a reduction of adverse outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Spyropoulos

Giannis

Cohen

et al. 2020

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…Khanna et al analyzed the Agency for Healthcare Research and Quality databases for Florida, Iowa, California and New York and found that URS and PCNL were associated with higher rates of ED visits than shock wave lithotripsy. 34 Such ED visits were more common in un/underinsured and Hispanic patients, whereas those with private insurance and highest income had significantly fewer post-procedural ED visits. 34 37 Race and insurance status have been shown to influence followup after ureteral stent placement, as well as return appointments after stent removal.…”

Section: Surgical Outcomesmentioning

confidence: 94%

“…34 Such ED visits were more common in un/underinsured and Hispanic patients, whereas those with private insurance and highest income had significantly fewer post-procedural ED visits. 34 37 Race and insurance status have been shown to influence followup after ureteral stent placement, as well as return appointments after stent removal. In a retrospective study adjusted for age, sex, race, surgical urgency (elective vs emergent), and insurance status, Javier-DesLoges et al reported that Black race was an independent predictor of missed followup after placement of a ureteral stent.…”

Section: Surgical Outcomesmentioning

confidence: 94%

Disparities in Kidney Stone Disease: A Scoping Review

et al. 2021

View full text Add to dashboard Cite

Purpose: We reviewed the available evidence regarding health disparities in kidney stone disease to identify knowledge gaps in this area. Materials and Methods: A literature search was conducted using PubMed Ò , Embase Ò and Scopus Ò limited to articles published in English from 1971 to 2020. Articles were selected based on their relevance to disparities in kidney stone disease among adults in the United States. Results: Several large epidemiological studies suggest disproportionate increases in incidence and prevalence of kidney stone disease among women as well as Black and Hispanic individuals in the United States, whereas other studies of comparable size do not report racial and ethnic demographics. Numerous articles describe disparities in imaging utilization, metabolic workup completion, analgesia, surgical intervention, stone burden at presentation, surgical complications, followup, and quality of life based on race, ethnicity, socioeconomic status and place of residence. Differences in urinary parameters based on race, ethnicity and socioeconomic status may be explained by both dietary and physiological factors. All articles assessed had substantial risk of selection bias and confounding. Conclusions: Health disparities are present in many aspects of kidney stone disease. Further research should focus not only on characterization of these disparities but also on interventions to reduce or eliminate them.

show abstract

“…The secondary endpoint was the reintervention rate. To demonstrate a difference of 15% in the urinary symptoms index between populations with a statistical power of 85%, a sample size of 60 patients in each group was required 9 . We applied an intention-to-treat analysis and deleted listwise if data were missing.…”

Section: Methodsmentioning

confidence: 99%

“…Do urologists encounter problems when omitting to stent more often than the literature indicates? Khanna et al reported that of 151,006 patients who underwent URS, 10.6% visited the emergency department postoperatively [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Striking a balance: outcomes of short-term Mono-J placement following ureterorenoscopy

Reicherz

Maas²,

Reike

et al. 2021

Urolithiasis

View full text Add to dashboard Cite

To evaluate factors affecting the outcomes of short-term Mono-J insertion for 6 h following ureteroscopic stone removal. Patients treated with a Mono-J for 6 h after ureterorenoscopy and stone removal were analysed. FaST 1 and 2 (Fast Track Stent Studies), two consecutive single academic centre studies, were conducted between August 2014 and April 2018. In each study, we randomized patients with renal or ureteral calculi to two groups before ureterorenoscopy. FaST 1 compared a Mono-J insertion for 6 h versus Double-J insertion for 3–5 days after ureterorenoscopy. FaST 2 compared a Mono-J insertion to a tubeless procedure in the same clinical setting. All patients were pre-stented for 3–5 days before URS. The study endpoint was stent-related symptoms as assessed by a validated questionnaire (USSQ). Results were stratified by clinical parameters, stone characteristics and operation details. 108 of 156 initially randomized patients undergoing ureterorenoscopy were included. USSQ scores covering the time 3–5 weeks after stone removal showed a significantly reduced urinary symptoms and pain index compared to the scores before ureterorenoscopy. USSQ results before and after stone removal did not correlate with stone size or operation time and did not differ significantly depending on stone localization, the treating endourologist, or ureterorenoscopic device used (p > 0.05). Six patients (5%) required reintervention. Following secondary ureterorenoscopy and ureteral drainage with a Mono-J for 6 h, quality of life is independent of stone size and localization, operation time, the treating endourologist, and the URS device used.

show abstract

Postoperative Emergency Department Visits After Urinary Stone Surgery: Variation Based on Surgical Modality

Cited by 9 publications

References 23 publications

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Disparities in Kidney Stone Disease: A Scoping Review

Striking a balance: outcomes of short-term Mono-J placement following ureterorenoscopy

Contact Info

Product

Resources

About