Predictors of Follow-Up of Pediatric Stone Patients After Surgical Intervention - An Interim Analysis
Megan Stout, MD1, Nora Thompson, CCRC2, Jason Benedict, MS3, Seth Alpert, MD2, Daniel Dajusta, MD2, Molly Fuchs, MD2, Rama Jayanthi, MD2, Daryl Mcleod, MD2, Christina Ching, MD2.
1The Ohio State University Wexner Medical Center, Columbus, OH, USA, 2Nationwide Children's Hospital, Columbus, OH, USA, 3The Ohio State University College of Medicine, Columbus, OH, USA.
BACKGROUND: Postoperative follow-up after kidney stone surgery is important. It evaluates surgical success and enables preventative strategies. Prior studies have found that social and demographic factors can influence medical compliance in adult kidney stone patients; there is limited data, however, of what predicts compliance in the pediatric patient population. We sought to identify factors influencing pediatric stone patient follow-up following stone intervention. METHODS: All patients having undergone kidney stone surgery at our academic pediatric hospital between January 2019 - December 2020 were identified through the use of CPT codes specific to ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. Electronic charts were retrospectively reviewed for basic demographics as well as social factors such as home distance from the hospital, insurance status, and primary caregiver. For each discrete stone episode (defined as any care for a stone within a 6 month window), we also abstracted information on patient presentation, stone characteristics, and characteristics of intervention. Appropriate follow-up compliance was reported as having a scheduled and attended provider visit within 6 months after surgery. A statistical analysis was performed for factors associated with follow-up using Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. RESULTS: Our interim analysis was performed on 111 pediatric patients, with the majority being non-Hispanic white (91%) and female (69%). The median age at surgery was 15.5 years (IQR 11.0, 17.3). More than half had a family history of kidney stones (55%). The majority of patients underwent ureteroscopy (87%). The majority of patients had been evaluated in the ED for their stone prior to their surgery (72%). In general, almost all had a postop provider visit scheduled after surgery (107; 97%). Of those patients, 82 (77%) attended that visit. The majority of patients had a postop renal ultrasound scheduled (102; 92%) with most receiving that ultrasound (82; 80%). 65% of patients had a postop 24-hour urine ordered, with 54% of those completing the study. The attached table demonstrates metrics compared between groups (Table 1). In this initial limited analysis, we found older patients, with public insurance, from a single parent home, and in whom surgery was scheduled through the Emergency Department were more likely to be noncompliant with postop follow-up (p≤0.03). Not surprisingly, postop renal ultrasound and 24-hour urine study were primarily done only if a patient attended their visit, although there were a few patients with these studies performed despite lack of provider follow-up.
CONCLUSIONS: Kidney stone disease is not benign and surgery is not without risk. We identify potential -predictors of pediatric follow-up, although data collection is still ongoing to enable a more robust analysis of a larger cohort. We hope to predict factors that could be used to help at risk patient populations for non-compliance with post-surgical kidney stone follow-up. It does not appear 24 hour urine studies are well utilized.
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