Category: Clinical Stones: PCNL
Introduction & Objective :
Percutaneous Nephrolithomy (PCNL) is a complex, multi-step surgery that has shown a steady increase in use over the last decade in the US. We sought to evaluate the trends and factors associated with PCNL usage across New York State (NYS). Our goal was to characterize patient demographics and socioeconomic factors across high, medium, and low volume institutions.
We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2006-2014 using ICD-9 Procedure Codes 55.04 (Percutaneous Nephrostomy with fragmentation) for all hospital discharges. Patient demographics including age, gender, race, insurance status, and length of hospital stay were obtained. We characterized each hospital as a low, medium, or high volume center by year. Patient and hospital demographics were compared and reported using chi-square analysis and student t-test for categorical and continuous variables respectively, with statistical significance as a p-value of
Results : We identified a total of 4,576 procedures performed from 2006 to 2014 at a total of 77 hospitals in New York State (Table 1). Total PCNL volume performed across all NYS hospitals increased in the last decade, with the greatest amount of procedures performed in 2012-2013. Low Volume institutions were more likely to provide care to minority populations (21.4% vs. 17.3%, p<0.001) and those with Medicaid (25.5% vs. 21.5%, p<0.001). High volume institutions provided care to patients with private insurance (42.1% vs. 34.0%, p<0.001) and had a shorter length of stay (3.3 days vs. 4.1 days, p<0.001).
Conclusions : Our data provides insight into the patient demographics of those treated at high-, medium-, and low-volume hospitals for PCNL across NYS. Significant differences in race, insurance status, and length of stay were noted between Low and High Volume institutions, indicating that racial and socioeconomic factors play a role in access to care at high volume centers.
Neel Patel– Resident, New York Medical College, Valhalla, New York
Suraj Parikh– Medical Student, New York Medical College, Valhalla, New York
Feng Guo– New York Medical College, Valhalla, New York
Jonathan Bloom– Research Fellow, National Cancer Institute, Bethesda, Maryland
Ariel Schulman– Duke University, Durham, North Carolina
Sean Fullerton– New York Medical College, Valhalla, New York
John Phillips– New York Medical College, Valhalla, New York
Muhammad Choudhury– New York Medical College, Valhalla, New York
Majid Eshghi– New York Medical College, Valhalla, New York