Category: Clinical Stones: Outcomes
Introduction & Objective :
Risk factors for kidney stone formation and recurrence are diverse. Type of initial stone removal procedure likely affects rates of recurrence and need for repeat stone removal procedure. In this study, we examine the need for repeat stone removal procedure more than 90 days after initial stone removal procedure. Specifically, we assess the risk of repeat procedure between patients receiving percutaneous nephrolithotomy (PCNL), extracorporeal shockwave lithotripsy (ESWL), and ureteroscopy (URS).
We identified 195,011 patients using the 2006-2014 Truven MarketScan® Commercial Claims and Encounters database that received a stone removal procedure, did not have a known kidney stone diagnosis prior to the procedure, and were enrolled in the database for at least one year before and after the index procedure. We used ICD-9-CM diagnosis codes to identify comorbidities and used CPT codes to identify index and event stone removal procedures. Analysis was performed with a Cox proportional hazard’s model.
The incidences of repeat stone procedures per 100 person years for PCNL, ESWL, URS, and open stone surgery was 10.2, 6.8, 4.4 and 5.5. With URS as a reference, we found the risk of repeat procedure was greatest among patients receiving PCNL (HR 2.07, 95% CI 1.95-2.21) and then ESWL (HR 1.54, 95% CI 1.50-1.57). Open stone removal had a similar hazard to URS (HR 1.17, 95% CI 0.97-1.41).
Conclusions : ESWL was associated with a greater hazard of receiving another stone removal procedure compared URS. This supports prior research suggesting a higher probability of repeat procedure among patients receiving ESWL compared to URS. Expectedly, PCNL was associated with the highest hazard of repeat procedure, likely reflecting greater stone burden in these patients.
Steven Monda– St Louis, Missouri
Joel Vetter– Statistician, Washington University in St. Louis, Saint Louis, Missouri
Margaret Olsen– St. Louis, Missouri
Matthew Keller– St. Louis, Missouri
Michael Chevinsky– Saint Louis, Missouri
Vasian Markollari– St. Louis, Missouri
Ramakrishna Venkatesh– Professor, Washington University in St. Louis, Saint Louis, Missouri
Alana Desai– Saint Louis, Missouri
St Louis, Missouri
Steven Monda is a fourth year medical student at Saint Louis University. He performs urological research at Washington University in St. Louis where he completed his Master of Science in Clinical Investigation.