Medical Expulsive Therapy versus Early Endoscopic Stone Removal for Acute Renal Colic: An Instrumental Variable Analysis
Medical Expulsive Therapy versus Early Endoscopic Stone Removal for Acute Renal Colic: An Instrumental Variable Analysis
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DOI：
10.1016/j.juro.2013.03.040
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发表时间：
2013-09-01
影响因子：
6.6
通讯作者：
Hollenbeck, Brent K.
中科院分区：
文献类型：
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作者：
Hollingsworth, John M.;Norton, Edward C.;Hollenbeck, Brent K.
目的：使用药物排石疗法加速结石排出，可能减少肾绞痛发作前后的费用。然而，这些效率的提高可能会减轻，如果患者治疗与医疗驱逐治疗有频繁的医疗保健遇到的痛苦，而等待结石pass.Materials和方法：使用索赔数据（2002年至2006年），我们确定了成年男性急性肾绞痛。我们比较了早期内镜下取石与早期药物排石治疗的6周支付以及住院和急诊复诊频率。为了解释未测量的混杂因素，我们进行了一个工具变量分析，利用变化的基础上，一周的一天，病人的第一次急诊科visitingoccurred.Results：总体上1,835和4,397名男子进行了医疗驱逐治疗或早期内镜下取石，分别推荐的治疗。尽管男性在急诊就诊的时间上存在微小的差异，但周末就诊与接受药物驱逐治疗密切相关（p < 0.001）。两阶段最小二乘回归显示，接受药物驱逐治疗的男性，无论是哪种治疗的候选人，6周的支付都要低10倍（p < 0.001）。虽然住院的频率没有差异，这些人更有可能有一个重复的急诊科就诊相比，那些谁接受了内镜下取石（68.8%对39.6%，分别为，p = 0.025）。结论：医疗驱逐治疗的结果是混合的，较低的6周付款，但更频繁的重复急诊科就诊。这些数据告知患者谁是候选人的医疗驱逐治疗或内镜下取石时，作出决定，他们的照顾。
Purpose: The use of medical expulsive therapy to hasten stone passage potentially decreases expenditures around episodes of renal colic. However, these efficiency gains may be mitigated if patients treated with medical expulsive therapy have frequent health care encounters due to pain while waiting for the stones to pass.Materials and Methods: Using claims data (2002 to 2006) we identified adult men with acute renal colic. We compared 6-week payments as well as frequency of hospitalization and emergency department revisits associated with an initial course of medical expulsive therapy with those for early endoscopic stone removal. To account for unmeasured confounding we performed an instrumental variable analysis, exploiting variation in recommended treatments based on the day of the week that a patient's first emergency department visit occurred.Results: Overall 1,835 and 4,397 men underwent medical expulsive therapy or early endoscopic stone removal, respectively. Although minimal differences existed between men with respect to the day of the week of emergency department presentation, weekend encounters were strongly associated with receiving medical expulsive therapy (p < 0.001). Two-stage least squares regression revealed 6-week payments to be tenfold lower for men on medical expulsive therapy who were candidates for either treatment (p < 0.001). While there was no difference in frequency of hospitalization, these men were more likely to have a repeat emergency department visit compared to those who underwent endoscopic stone removal (68.8% vs 39.6%, respectively, p = 0.025).Conclusions: Findings on medical expulsive therapy are mixed, with lower 6-week payments but more frequent repeat emergency department visits. These data inform patients who are candidates for medical expulsive therapy or endoscopic stone removal when making decisions about their care.