Shock Wave Lithotripsy vs Ureteroscopy: Variation in Surgical Management of Kidney Stones at Freestanding Children's Hospitals

Wang, Hsin‐Hsiao Scott; Huang, Lin; Routh, Jonathan C.; Nelson, Caleb P.

doi:10.1016/j.juro.2011.12.010

Cited by 34 publications

(22 citation statements)

References 14 publications

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“…Consequently, there is unwanted variability in evaluation and treatment practices for children with nephrolithiasis, including poor adherence to guidelines aimed at reducing radiation exposure among children with suspected nephrolithiasis and use of surgical interventions that are dependent more on local availability and ease of use than clinical indications (20)(21)(22). The rising incidence of nephrolithiasis among younger girls also has important public health implications.…”

Section: Discussionmentioning

confidence: 99%

Annual Incidence of Nephrolithiasis among Children and Adults in South Carolina from 1997 to 2012

Tasian

Ross

Song³

et al. 2016

Clinical Journal of the American Society of Nephrology

211

130

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Background and objectives The prevalence of nephrolithiasis in the United States has increased substantially, but recent changes in incidence with respect to age, sex, and race are not well characterized. This study examined temporal trends in the annual incidence and cumulative risk of nephrolithiasis among children and adults living in South Carolina over a 16-year period.Design, setting, participants, & measurements We performed a population-based, repeated cross-sectional study using the US Census and South Carolina Medical Encounter data, which capture all emergency department visits, surgeries, and admissions in the state. The annual incidence of nephrolithiasis in South Carolina from 1997 to 2012 was estimated, and linear mixed models were used to estimate incidence rate ratios for age, sex, and racial groups. The cumulative risk of nephrolithiasis during childhood and over the lifetime was estimated for males and females in 1997 and 2012.Results Among an at-risk population of 4,625,364 people, 152,925 unique patients received emergency, inpatient, or surgical care for nephrolithiasis. Between 1997 and 2012, the mean annual incidence of nephrolithiasis increased 1% annually from 206 to 239 per 100,000 persons. Among age groups, the greatest increase was observed among 15-19 year olds, in whom incidence increased 26% per 5 years (incidence rate ratio, 1.26; 95% confidence interval, 1.22 to 1.29). Adjusting for age and race, incidence increased 15% per 5 years among females (incidence rate ratio, 1.15; 95% confidence interval, 1.14 to 1.16) but remained stable for males. The incidence among blacks increased 15% more per 5 years compared with whites (incidence rate ratio, 1.15; 95% confidence interval, 1.14 to 1.17). These changes in incidence resulted in doubling of the risk of nephrolithiasis during childhood and a 45% increase in the lifetime risk of nephrolithiasis for women over the study period.Conclusions The incidence of kidney stones has increased among young patients, particularly women, and blacks.

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Section: Discussionmentioning

confidence: 99%

Annual Incidence of Nephrolithiasis among Children and Adults in South Carolina from 1997 to 2012

Tasian

Ross

Song³

et al. 2016

Clinical Journal of the American Society of Nephrology

211

130

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“…For patients with kidney stones, we defined the duration of the kidney stone episode to extend from 1 month before to 6 months after the first kidney stone claim to capture the initial diagnosis, treatment, and followup imaging that would be obtained after spontaneous stone passage or surgical removal. 9,14 We identified all ultrasound, CT, KUB, IVP, and MRI performed during the kidney stone episode by using imaging billing codes. The order of imaging was defined by the imaging claim dates.…”

Section: Methodsmentioning

confidence: 99%

Use of and Regional Variation in Initial CT Imaging for Kidney Stones

et al. 2014

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OBJECTIVE: We sought to determine the prevalence of initial computed tomography (CT) utilization and to identify regions in the United States where CT is highly used as the first imaging study for children with nephrolithiasis. METHODS: We performed a cross-sectional study in 9228 commercially insured children aged 1 to 17 years with nephrolithiasis who underwent diagnostic imaging in the United States between 2003 and 2011. Data were obtained from MarketScan, a commercial insurance claims database of 17 827 229 children in all 50 states. We determined the prevalence of initial CT use, defined as CT alone or CT performed before ultrasound in the emergency department, inpatient unit, or outpatient clinic, and identified regions of high CT utilization by using logistic regression. RESULTS: Sixty-three percent of children underwent initial CT study and 24% had ultrasound performed first. By state, the proportion of children who underwent initial CT ranged from 41% to 79%. Regional variations persisted after adjusting for age, gender, year of presentation, and insurance type. Relative to children living in West South Central states, the highest odds of initial CT utilization were observed for children living in the East South Central US Census division (odds ratio: 1.27; 95% confidence interval: 1.06–1.54). The lowest odds of initial CT were observed for children in the New England states (odds ratio: 0.48; 95% confidence interval: 0.38–0.62). CONCLUSIONS: Use of CT as the initial imaging study for children with nephrolithiasis is highly prevalent and shows extensive regional variability in the United States. Current imaging practices deviate substantially from recently published guidelines that recommend ultrasound as the initial imaging study.

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“…6, 18 Such variation has been observed in other clinical situations in which consensus is lacking on the best practices. 19, 20 Unwarranted variation is a reality within the medical care system and has been documented repeatedly using a wide range of data sources. Care pattern variation has also been demonstrated, in certain circumstances, to be associated with poorer clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida

et al. 2016

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Background Bladder dysfunction in spina bifida (SB) patients can lead to significant morbidity due to renal insufficiency. Indications for surgery vary between institutions, and the impact is unclear. Our objective was to examine trends and variations in urologic interventions and chronic renal insufficiency in SB patients. Methods We reviewed the Nationwide Inpatient Sample (NIS) for all SB patients treated from 1998–2011. We used ICD-9-CM codes to identify urologic surgery and chronic renal insufficiency (CRI). We calculated Spearman’s correlation coefficients between rates of SB-related bladder surgeries and rates of CRI outcomes by state. Linear regression models were fitted to investigate the associations between rates of SB-related surgery and CRI across treatment years. Results We identified 427,616 SB admissions (mean age 26y, 56% female); 35,249(8%) were for CRI and 11,078 (3%) were for surgery. Over the study period, CRI rates doubled (6–12%) and surgery rates declined (2.0–1.8%). There was a moderately weak, inverse association between surgery and CRI rates over time (r=−0.3, p=0.06) and by state (r=−0.3, p=0.04). On multivariate analysis, higher rates of surgery were associated with the state in which the patient was treated (p<0.001), younger age (p<0.001), and hospital teaching status (p<0.001). In contrast, CRI was not associated with SB-related surgery (p=0.67). Conclusions We observed a temporal and geographic trend toward decreasing urologic surgery and increasing CRI rates in SB and a wide variation in urologic surgical rates among states. Further study is needed to determine the factors behind these trends and variations in SB management.

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Shock Wave Lithotripsy vs Ureteroscopy: Variation in Surgical Management of Kidney Stones at Freestanding Children's Hospitals

Abstract: There is wide variation in procedure choice for children with kidney stones at freestanding children's hospitals in the United States. Treatment choice depends significantly on the hospital at which a patient undergoes treatment.

Cited by 34 publications

References 14 publications

Annual Incidence of Nephrolithiasis among Children and Adults in South Carolina from 1997 to 2012

Annual Incidence of Nephrolithiasis among Children and Adults in South Carolina from 1997 to 2012

Use of and Regional Variation in Initial CT Imaging for Kidney Stones

Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida

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