The impact of unplanned postprocedure visits in the management of patients with urinary stones
The impact of unplanned postprocedure visits in the management of patients with urinary stones
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DOI：
10.1016/j.surg.2013.12.013
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发表时间：
2014-05-01
期刊：
影响因子：
3.8
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
--
作者：
Scales, Charles D., Jr.;Saigal, Christopher S.;Litwin, Mark S.
背景资料。计划外后续护理是卫生政策关注的焦点，最近根据《平价医疗法案》实施的经济处罚就是明证。然而，到目前为止，非计划的术后护理仍然很差，特别是对肾结石患者。我们的目标是描述计划外、高敏感度的随访在治疗尿路结石患者中的频率、变异和经济影响。我们确定了接受经皮肾取石术、输尿管镜或冲击波碎石术治疗结石疾病的私人保险患者。主要结果是在手术后30天内出现急诊科就诊或住院。多变量模型估计了计划外就诊的几率和这些就诊的增量成本，并控制了重要的协变量。我们确定了93,523个碎石或取出结石的初始程序。总体而言，每7名患者中就有1名进行了计划外的术后访问。非计划就诊在冲击波碎石术后最不常见(12%)，在输尿管镜检查和经皮肾取石术后发生的频率相似(15%)。在大容量设施进行手术导致计划外就诊的可能性大大降低(优势比0.80，95%可信区间[95%CI]0.74-0.87，P
Background. Unplanned follow-up care is the focus of intense health policy interest, as evidenced by recent financial penalties imposed under the Affordable Care Act. To date, however, unplanned postoperative care remains poorly characterized, particularly for patients with kidney stones. Our objective was to describe the frequency, variation, and financial impact of unplanned, high-acuity, follow-up visits in the treatment of patients with urinary stone disease.Methods. We identified privately insured patients undergoing percutaneous nephrostolithotomy,,ureteroscopy, or shock-wave lithotripsy for stone disease. The primary outcome was occurrence of an emergency department visit or hospital admission within 30 days of the procedure. Multivariable models estimated the odds of an unplanned visit and the incremental cost of those visits, controlling for important covariates.Results. We identified 93,523 initial procedures to fragment or remove stones. Overall, 1 in 7 patients had an unplanned postprocedural visit. Unplanned visits were least common after shock-wave lithotripsy (12%) and occurred with similar frequency after ureteroscopy and percutaneous nephrostolithotomy (15%). Procedures at high-volume facilities were substantially less likely to result in an unplanned visit (odds ratio 0.80, 95% confidence interval [95% CI] 0.74-0.87, P