482 VARIATION IN SECOND PROCEDURES FOR STONE FRAGMENTATION IN THE UNITED STATES (2010)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2010482 VARIATION IN SECOND PROCEDURES FOR STONE FRAGMENTATION IN THE UNITED STATES Charles Scales, Tracey Krupski, Lesley Curtis, Margaret Pearle, Brian Matlaga, Yair Lotan, Christopher Saigal, Mark Litwin, and Glenn Preminger Charles ScalesCharles Scales Durham, NC More articles by this author , Tracey KrupskiTracey Krupski Charlottesville, VA More articles by this author , Lesley CurtisLesley Curtis Durham, NC More articles by this author , Margaret PearleMargaret Pearle Dallas, TX More articles by this author , Brian MatlagaBrian Matlaga Baltimore, MD More articles by this author , Yair LotanYair Lotan Dallas, TX More articles by this author , Christopher SaigalChristopher Saigal Los Angeles, CA More articles by this author , Mark LitwinMark Litwin Los Angeles, CA More articles by this author , and Glenn PremingerGlenn Preminger Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.557AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Healthcare expenditures for the management of urinary lithiasis are second only to those for urinary tract infection among urologic disorders. While both URS and SWL are first-line therapies for appropriately selected calculi, little is known about real-world practice patterns for these technologies. Our objective was to document practice patterns and variation in second procedures for stone fragmentation. METHODS We used the Medicare 5% sample to identify a cohort of beneficiaries undergoing SWL or URS (with or without stone fragmentation) of renal or ureteral calculi. Beneficiaries had an incident stone encounter from 1997 –2007. Patient and provider characteristics were identified from Medicare files. Practice setting characteristics were linked to claims using data from the American Hospital Association and the Area Resource File from the United States Census Bureau. A multivariable regression model identified factors associated with a second procedure (URS or SWL) within 120 days of the initial procedure. RESULTS The cohort comprised 9358 beneficiaries who underwent an initial procedure, of whom 61% were male and 92% were white. Fifty-nine percent of beneficiaries were aged between 66 –74 years. SWL was used in 5208 (56%) beneficiaries, while URS (with or without fragmentation) was used in 4150 (44%). Controlling for patient demographics, year, provider volume, practice setting, and ownership, the odds of a second procedure following initial shock wave lithotripsy were 1.54 times that of ureteroscopy with laser fragmentation (p<0.001). Beneficiaries treated by a high volume SWL provider were more likely to undergo an additional procedure (OR 1.18, p = 0.0124), as were those beneficiaries treated at a teaching facility (OR 1.23, p = 0.026). Stratification by ureteral and renal calculi yielded similar results. For URS and SWL, the second procedure was most commonly the same as the first. CONCLUSIONS In a nationally representative cohort, patients undergoing URS are significantly less likely to undergo additional procedures to treat stones. A significantly higher second procedure rate following SWL may contribute to the high cost of management for stone disease. Further investigation is required to understand factors driving these practice patterns and their contribution to healthcare costs. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e190 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Scales Durham, NC More articles by this author Tracey Krupski Charlottesville, VA More articles by this author Lesley Curtis Durham, NC More articles by this author Margaret Pearle Dallas, TX More articles by this author Brian Matlaga Baltimore, MD More articles by this author Yair Lotan Dallas, TX More articles by this author Christopher Saigal Los Angeles, CA More articles by this author Mark Litwin Los Angeles, CA More articles by this author Glenn Preminger Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...