Jorge F Pereira1, Paul Bower2,3, Eric Jung2,3, Egor Parkhomenko4, Timothy Tran2,3, Simone Thavaseelan2,3, Gyan Pareek2,3,5. 1. Columbia University Division of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA. jorge.pereira@msmc.com. 2. Warren Alpert Medical School of Brown University, Providence, RI, USA. 3. Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA. 4. Department of Urology, University of California, Irvine, Orange, CA, USA. 5. Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA.
Abstract
PURPOSE: Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists. METHODS: The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices. RESULTS: 233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01). CONCLUSION: Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.
PURPOSE: Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists. METHODS: The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices. RESULTS: 233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01). CONCLUSION: Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.
Entities:
Keywords:
Cost; Practice patterns; Ureteral stent; Ureteroscopy
Authors: Stephan Seklehner; Karl-Dietrich Sievert; Richard Lee; Paul F Engelhardt; Claus Riedl; Thomas Kunit Journal: Int Urol Nephrol Date: 2017-02-14 Impact factor: 2.370
Authors: P G Borboroglu; C L Amling; N S Schenkman; M Monga; J F Ward; N Y Piper; J T Bishoff; C J Kane Journal: J Urol Date: 2001-11 Impact factor: 7.450
Authors: Robert R Byrne; Brian K Auge; John Kourambas; Ravi Munver; Fernando Delvecchio; Glenn M Preminger Journal: J Endourol Date: 2002-02 Impact factor: 2.942
Authors: M C Sighinolfi; S Micali; S De Stefani; A Mofferdin; M Grande; A Grande; M Giacometti; N Ferrari; M Rivalta; G Bianchi Journal: J Urol Date: 2007-05-17 Impact factor: 7.450