2 Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis
2 Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis
复制标题
DOI：
10.1089/end.2018.0177
复制
发表时间：
2018-09-26
影响因子：
2.7
通讯作者：
Venkatesh, Ramakrishna
中科院分区：
文献类型：
--
作者：
Du, Kefu;Wang, Robert S.;Venkatesh, Ramakrishna
目的：确定体位镜 (URS) 意外遭遇的可避免预测因素，并尽量减少 30 天的遭遇。材料和方法：我们对 2016 年 1 月至 6 月期间因尿石症接受 URS 的患者进行了回顾性图表审查和电话调查。单变量和多变量分析评估了意外遭遇的潜在预测因素。结果：在 157 名患者中，有 44 例 (28.0%) 患者无意发起临床电话，23 例 (14.6%) 就诊急诊室 (ED)，8 例 (5.1%) 再次入院，其中疼痛是就诊期间最常见的主诉。与较高电话率相关的因素包括首次结石手术（36.6% vs 20.9%，p=0.029）、门诊状态（30.3% vs 0%，p=0.021）、术中支架置入（31.2% vs 0%，p=0.006）和在家取出支架（58.8% vs 28.8%，p=0.014）。与急诊就诊率增加相关的因素是首次取石手术（22.5% vs 8.1%，p=0.011）和输尿管通路鞘（UAS）的使用（29.6% vs 11.8%，p=0.018）。与较高再入院率相关的因素包括较低的体重指数（23.9 vs 29.7，p=0.013）、双侧手术（20.0% vs 2.9%，p=0.010）和 UAS 使用（14.8% vs 3.1%，p=0.032）。结石负担、手术时间、查尔斯顿合并症和术前尿路感染与术后遭遇没有显着相关。结论：疼痛、首次结石治疗、输尿管支架的存在、门诊状态、双侧手术和 UAS 使用是 URS 术后发生的常见原因。适当的围手术期患者教育和咨询以及充分的疼痛管理可以最大限度地减少这些情况并提高治疗质量和患者满意度。
Objective: To identify avoidable predictors of postureteroscopy (URS) unplanned encounters and to minimize 30-day encounters. Materials and Methods: We performed retrospective chart review and telephone surveys on patients who underwent URS for urolithiasis between January and June 2016. Univariate and multivariable analyses evaluated for potential predictors of unplanned encounters. Results: Of 157 patients, there were 44 (28.0%) unplanned patient-initiated clinical phone calls, 23 (14.6%) emergency department (ED) visits, and 8 (5.1%) readmissions, with pain being the most common complaint during the encounters. Factors associated with a higher rate of phone calls include first-time stone procedure (36.6% vs 20.9%, p=0.029), outpatient status (30.3% vs 0%, p=0.021), intraoperative stent placement (31.2% vs 0%, p=0.006), and stent removal at home (58.8% vs 28.8%, p=0.014). Factors associated with increased rate of ED visits were first-time stone procedure (22.5% vs 8.1%, p=0.011) and ureteral access sheath (UAS) usage (29.6% vs 11.8%, p=0.018). Factors associated with a higher rate of readmissions were lower body mass index (23.9 vs 29.7, p=0.013), bilateral procedure (20.0% vs 2.9%, p=0.010), and UAS usage (14.8% vs 3.1%, p=0.032). Stone burden, operative time, Charleston comorbidity, and preoperative urinary tract infection were not significantly associated with postoperative encounters. Conclusions: Pain, first-time stone treatment, presence of a ureteral stent, outpatient status, bilateral procedures, and UAS usage were common reasons for postoperative encounters after URS. Appropriate perioperative patient education and counseling and adequate pain management may minimize these encounters and improve treatment quality and patient satisfaction.