Delays in Ureteroscopy and Shockwave Lithotripsy After Ureteral Stent Placement: Impact on Infectious Complications, Resource Use, and Medical Costs

Abstract

Purpose: To evaluate the effects of ureteral stent duration prior to ureteroscopy (URS) or shockwave lithotripsy (SWL) on infectious complications, healthcare resource utilization (HCRU), and costs. Materials and Methods: Patients who underwent URS/SWL within 6-months of ureteral stent placement were identified from commercial claims, categorized by time from stent placement to URS (0-15, 16-30, 31-60, and >60 days) or SWL (0-15, 16-30, and >30 days), and followed 1-month post-procedure. The relationship between ureteral stent duration and emergency department (ED) visits, inpatient admissions, infectious complications (pyelonephritis/sepsis), imaging, and costs was evaluated. Results: Mean time to URS (n=9,276 patients) was 21.3±24.4 days and SWL (n=4,689 patients) was 19.0±24.8 days. Compared to patients who underwent URS within 15 days of ureteral stent placement, URS 31-60 days after ureteral stent placement was significantly associated with inpatient admissions ( odds ratio [OR]: 2.56,95% confidence interval (CI): 2.03-3.22); infectious complications (OR: 2.82,95% CI: 2.09-3.81); imaging ( OR: 2.12, 95% CI: 1.82-2.46); and medical costs (OR: 1.49, 95% CI: 1.40-1.58). Compared to patients who underwent SWL within 15 days of ureteral stent placement, SWL more than 30 days after ureteral stent placement was significantly associated with ED visits (OR: 1.79, 95% CI: 1.37-2.34); inpatient admissions (OR: 3.34,95% CI: 2.38-4.69); infectious complications (OR: 3.54,95% CI: 2.20-5.70); imaging (OR: 2.65, 95% CI: 2.23-3.15); and medical costs (OR: 1.45, 95% CI: 1.36-1.54). Conclusions: URS or SWL >30 days after ureteral stent placement increased the likelihood of infectious complications, HCRU, and medical costs.