Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

被引：2

作者：

Tasian, Gregory E. ^{[1
,2
]}

Maltenfort, Mitchell G. ^{[3
]}

Rove, Kyle ^{[4
]}

Ching, Christina B. ^{[5
]}

Ramachandra, Puneeta ^{[6
]}

DeFoor, Bob ^{[7
]}

Fernandez, Nicolas ^{[8
]}

Forrest, Christopher B. ^{[3
,9
]}

Ellison, Jonathan S. ^{[10
]}

机构：

[1] Childrens Hosp Philadelphia, Div Urol, Dept Surg, Philadelphia, PA USA

[2] Univ Penn, Perelman Sch Med, Dept Biostat Epidemiol & Informat, Philadelphia, PA USA

[3] Childrens Hosp Philadelphia, Appl Clin Res Ctr, Philadelphia, PA USA

[4] Childrens Hosp Colorado, Div Urol, Dept Surg, Aurora, CO USA

[5] Nationwide Childrens Hosp, Dept Pediat Urol, Columbus, OH USA

[6] Nemours Childrens Hlth, Dept Surg, Div Urol, Wilmington, DE USA

[7] Cincinnati Childrens Hosp & Med Ctr, Div Urol, Dept Surg, Cincinnati, OH USA

[8] Seattle Childrens Hosp, Div Urol, Dept Surg, Seattle, WA USA

[9] Childrens Hosp Philadelphia, Dept Pediat, Philadelphia, PA USA

[10] Childrens Wisconsin & Med Coll Wisconsin, Dept Urol, Milwaukee, WI USA

来源：

JOURNAL OF UROLOGY | 2023年 / 209卷 / 06期

关键词：

pediatrics; lithotripsy; high-energy shock waves; stents; ureteroscopy; ASSOCIATION/ENDOUROLOGICAL SOCIETY GUIDELINE; SURGICAL-MANAGEMENT; YOUNG-ADULTS; CHILDREN; ADOLESCENTS; INSERTION; QUALITY; CALCULI; HEALTH;

D O I：

10.1097/JU.0000000000003389

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Purpose: Little is known about the impact of ureteral stents on youth having stone surgery. We evaluated the association of ureteral stent placement before or concurrent with ureteroscopy and shock wave lithotripsy with emergency department visits and opioid prescriptions among pediatric patients. Materials and Methods: We conducted a retrospective cohort study of individuals aged 0-24 years who underwent ureteroscopy or shock wave lithotripsy from 2009-2021 at 6 hospitals in PEDSnet, a research network that aggregates electronic health record data from children's health systems in the United States. The exposure, primary ureteral stent placement, was defined as a stent placed concurrent with or within 60 days before ureteroscopy or shock wave lithotripsy. Associations between primary stent placement and stone-related ED visits and opioid prescriptions within 120 days of the index procedure were evaluated with mixed-effects Poisson regression. Results: Two-thousand ninety-three patients (60% female; median age 15 years, IQR 11-17) had 2,477 surgical episodes; 2,144 were ureteroscopy and 333 were shock wave lithotripsy. Primary stents were placed in 1,698 (79%) ureteroscopy episodes and 33 (10%) shock wave lithotripsy episodes. Ureteral stents were associated with a 33% higher rate of emergency department visits (IRR 1.33; 95% CI 1.02-1.73) and a 30% higher rate of opioid prescriptions (IRR 1.30; 95% CI 1.10-1.53). The magnitudes of both associations were greater for shock wave lithotripsy. Results were similar for age <18 and were lost when restricted to concurrent stent placement. Conclusions: Primary ureteral stent placement was associated with more frequent emergency department visits and opioid prescriptions, driven by pre-stenting. These results support elucidating situations where stents are not necessary for youth with nephrolithiasis.

引用

页码：1194 / 1201

页数：8