Presentation Authors: Alexander Parker*, Bryan Pham, Joel Vetter, Ramakrishna Venkatesh, Alana Desai, St. Louis, MO
Introduction: Ureteroscopy (URS) is generally accepted as an outpatient procedure in most cases, however many patients have unplanned encounters following surgery. We sought to examine the patient conditions that affecting unplanned encounters including telephone calls, emergency department (ED) visits, and readmissions following URS.
Methods: A retrospective chart review was performed in a tertiary care hospital examining unplanned encounters defined as non-administrative, patient-initiated telephone calls, ED visits and hospital readmissions following URS. We examined psychologic and chronic pain syndromes as risk factors for unplanned encounters after ureteroscopic stone extraction. We identified 334 consecutive patients who underwent ureteroscopy in 2016. Patient-related factors were evaluated including age, gender, history of anxiety and/or depression, with or without medication, mobility issues,, as well as the chronic pain conditions of fibromyalgia, irritable bowel syndrome (IBS), and interstitial cystitis/pelvic pain syndrome (IC/PPS). We also assessed home stent removal and prior history of stone procedure as risk factors. Data was analyzed with univariate analysis via chi square analysis and multivariate logistic regression analysis.
Results: We found that 77/334 (23%) and 84/335 (25%) of patients were diagnosed with anxiety or depression, respectively, 19/334 (5.6%) carried a diagnosis of fibromyalgia (4), IBS (12) , or IC/PPS (5) (Table 1). On multivariate analysis, there was no statistically significant increase in patient-initiated phone calls or ED visits for patients with a diagnosis of anxiety, depression or chronic pain conditions. There was a statistical significance for ureteral stent removal at home and postoperative phone calls (p=0.008).
Conclusions: In patients carrying a diagnosis of anxiety, depression or chronic pain syndromes, there does not appear to be an increased rate of unplanned encounters. Patients instructed to remove a ureteral stent at home were more likely to call the physician. Further studies should be directed at better understanding the physiological mechanism for stent-related pain.