Category: Clinical Stones: Outcomes

MP31-17 - Impact of Acute Care Urology Service on Care of the Acute Stone Patient

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective : The acute care surgery model was introduced to facilitate timely evaluation and treatment of patients presenting to the emergency room (ER) with acute conditions. While this model has been rapidly adopted in General Surgery, there is a paucity of data in Urology. We sought to examine the impact of our new Acute Care Urology (ACU) service on timeliness of care for acute stone patients. The ACU team consists of five rotating physicians on a daily basis who triage acute consults from the ER and inpatient wards at a large tertiary referral center.


Methods : We conducted a retrospective review of all patients who underwent ureteral stent placement before (2012, pre-ACU) or after (2017, post-ACU) implementation of our ACU service. Only patients presenting to the ER and evaluated by the Urology team for an acute stone episode were included. Baseline demographic characteristics were recorded. The primary outcome was time from urological consult and/or stent placement to definitive stone intervention. Secondary outcomes included readmission rate (including repeat ER presentation) and lost to follow-up rate. Statistical analyses included Chi-Square, Cox proportional hazards model, and logistic regression with p<0.05 considered significant.


Results : A total of 139 patients met inclusion criteria (68 pre-ACU, 71 post-ACU). Patient demographics were similar between both groups. On univariate analysis, time to definitive stone treatment was significantly shorter in the post-ACU group compared to the pre-ACU group (median 18.5 vs. 31.5 days, p=0.015). There were no statistically significant differences between pre-ACU and post-ACU groups in readmission (19.1% vs. 15.5%, p=0.70) or lost to follow-up rates (17.6% vs. 21.1%, p=0.76). On multivariate analysis including age, gender, insurance status, primary language (English vs. Non-English), and ACU status, only post-ACU status was associated with significantly shorter time to intervention (HR 1.55, 95% CI: 1.02-2.36, p=0.041). For readmission rate, only younger age was associated with higher readmission rates (OR 0.94, 95% CI: 0.90-0.98, p=0.004). There were no significant differences between patients lost to follow-up and those who returned.


Conclusions : Implementation of a dedicated ACU service decreased time to definitive stone treatment. Additionally, there was a clinically meaningful decrease in readmissions with an ACU service. Future studies are needed to evaluate its impact on healthcare costs, patient satisfaction, and other acute urological conditions amenable to this model.

Nina Mikkilineni

Urology Resident
New York Presbyterian-Columbia University Medical Center
New York, New York

Nina Mikkilineni, MD is a Urology resident at New York Presbyterian-Columbia University Medical Center.

David Weiner

Assistant Professor of Urology
New York Presbyterian-Columbia University Medical Center
New York, New York

Gen Li

Assistant Professor
Mailman School of Public Health
New York, New York

Ojas Shah

Professor of Urology
New York Presbyterian-Columbia University Medical Center
New York, New York

Dr. Ojas Shah is the George F. Cahill Professor of Urology at Columbia University College of Physicians and Surgeons. He also serves as the Director of the Division of Endourology and Stone Disease at Columbia University Medical Center. His clinical and research interests include surgical and metabolic treatments of kidney stone disease, minimally invasive urologic surgery, upper urinary tract urothelial carcinoma (transitional cell carcinoma), ureteral strictures, ureteropelvic junction (UPJ) obstruction, and ureteral/renal reconstructive surgery. He serves as the principal investigator in many clinical research trials regarding the surgical or medical management of stone disease.

He is a graduate of the Honors Program in Medical Education at Northwestern University School of Medicine. He completed his general surgical and urologic training at New York University Medical Center. He spent an additional year at Wake Forest University Health Sciences Center as a fellow in endourology, laparoscopy and metabolic stone disease.

Dr. Shah is a nationally and internationally recognized expert in the medical and surgical management of patients with urinary stone disease. He recently served as a member of the American Urological Association’s Surgical Management of Stones Guidelines Committee. He was also recently appointed to the American Board of Urology’s Examination Committee. He is an active member of the Endourological Society, EDGE (Endourology Disease Group for Excellence) Research Consortium, and ROCK (Research on Calculous Kinetics) Society.

Dr. Shah is an Assistant Editor for the Journal of Urology, the most highly cited and amongst the most respected international journals in the field. He is also co-editor of the 5th Edition of Taneja’s Complications of Urologic Surgery which was released in 2018.

Kelly A. Healy

Assistant Professor of Urology
New York Presbyterian-Columbia University Medical Center
New York, New York