Unplanned Health Care Utilization after Ureteroscopy with Ureteral Stenting: Results from the Study to Enhance Understanding of Stent-Associated Symptoms Cohort.

Abstract

Background: Urinary stone disease (USD) often necessitates ureteroscopy with ureteral stenting. We assessed the frequency and risk factors associated with unplanned health care utilization related to ureteroscopy with ureteral stenting within 30 postoperative days, using data from the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study. Methods: Demographic, medical, surgical, and postoperative data were collected prospectively across four clinical centers for participants undergoing ureteroscopy for USD. Any utilization of health care (urgent care/emergency room or in-person clinical encounter) within 30 days was assessed for potential relationship to the stone procedure. We used univariable and multivariable logistic regression models to evaluate the associations between potential prespecified covariates and the primary outcome of unplanned encounter (UE). Results: A total of 484 participants (451 adults) underwent ureteroscopy (424 unilateral and 60 bilateral). Mean age was 49 years, and 47% were female. All postoperative clinical encounters within 30 days were reviewed to determine if they were unplanned and surgery related. Overall, 49 of the participants (10%) had at least one UE within 30 days, and 24/49 (49%) were an emergency room visit and/or hospitalization. Age, race, sex, and previous stone history were not statistically associated with a UE. Participants with a chronic pain condition were three times more likely to have a UE. Surgical duration, use of a ureteral access sheath, stent diameter, or irrigation method did not differ between the groups in a multivariable logistic model. Conclusions: The prevalence of unplanned health care utilization related to ureteroscopy and stenting for USD in our cohort was 10%. The presence of a chronic pain condition was an independent predictor of a UE. These findings may help identify patients at higher risk of utilizing health care resources following USD surgery and could enable proactive targeted interventions.