Stent Omission in Presented Patients Undergoing Ureteroscopy Decreased Unplanned Healthcare Utilization.
Journal of Urology
INTRODUCTION AND OBJECTIVE:
AUA guidelines advocate stent omission after uncomplicated URS in patients with ≥1.5 cm stones, but prestenting is not considered as criteria for stent omission. We aimed to determine if prestented patients should be included in the criteria for stent omission within the Michigan Urological Surgery Improvement Collaborative (MUSIC).
Using the MUSIC clinical registry we identified uncomplicated URS cases from 2016 to 2019. We defined this as low comorbidity (≤1 CCI), no anticoagulation/antiplatelet therapy, no anatomic abnormality, no positive preoperative urinalysis or culture, single stage procedure for ≤1.5 cm stone, and no intraoperative complication. We divided cases into prestented and non-prestented groups. We assessed practice and surgeon variation in stent omission in those with ≥5 cases in each category. We fit multivariable models to assess if prestenting was associated with 30-day emergency department (ED) visits.
In total, 6263 uncomplicated URS were performed in 33 practices by 209 surgeons. 2243 (36%) patients were prestented. Stent omission rates in prestented and non-prestented cases were 47.3% (range 0-77.8%) and 26.3% (range 0-62.1%), respectively (Fig. A). 15/17 (88%) practices performed stent omission at higher rates if the patient was prestented. Surgeon-level data in prestented patients demonstrated stent omission rates from 0 to 100%, with 22.3% never performing stent omission (Fig. B). Prestented cases that were stented, compared to stent omission, had higher rates of ED visit (6% vs 3.1%, p<0.0001) and unplanned hospitalization (2.6% vs 1.3%, p<0.0001). In non-prestented cases, there were no significant differences in ED visits (7.7% vs 8.3%; p=0.48) or hospitalization (2.2% vs 1.9%; p=0.63) in those stented vs stent omitted, respectively. Multivariate analysis demonstrated stenting in prestented cases was associated with increased ED visits (OR: 2.12; 95%CI: 1.37-3.29, p<.0.001).
Data from our clinical registry shows that stent omission in prestented patients undergoing URS decreases unplanned healthcare utilization, and this scenario is an opportunity for quality improvement. Prestenting should be considered an inclusion criteria for stent omission in the AUA stone management guidelines.
DiBianco JM, Dupati A, Daignault-Newton S, Kachroo N, Seifman B, Pimentel H, et al. Stent omission in presented patients undergoing ureteroscopy decreased unplanned healthcare utilization. J Urol. 2021 Sep;206(suppl 3):e924.