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Trends and inequalities in the surgical management of ureteric calculi in the USA
Author(s) -
Seklehner Stephan,
Laudano Melissa A.,
Jamzadeh Asha,
Del Pizzo Joseph J.,
Chughtai Bilal,
Lee Richard K.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12372
Subject(s) - medicine , ureteroscopy , current procedural terminology , logistic regression , ethnic group , odds ratio , multivariate analysis , urology , surgery , ureter , sociology , anthropology
Objective To assess trends in the surgical management of ureteric calculi over a 10‐year period.Materials and Methods An analysis of the 5% Medicare Public Use Files, from 2001, 2004, 2007 and 2010, was performed to assess the use of ureteroscopy ( URS ), extracorporal shockwave lithotripsy ( ESWL ) and ureterolithotomy ( UL ) in treating ureteric calculi. Patients were identified using International Classification of Diseases 9th edition (Clinical Modification) and Current Procedure Terminology codes. Statistical analyses using the F isher and chi‐squared tests, and multivariate logistic regression analysis (dependent variables: URS , ESWL , UL , treatment, no treatment; independent variables: age, gender, ethnicity, geography and year of treatment) were performed.Results A total of 299 920 patients with ureteric calculi were identified. Of these, 115 200 underwent surgery. Men (odds ratio [ OR ] = 1.15, P < 0.001) were more likely, while patients from ethnic minorities ( OR = 0.84, P = 0.004) were less likely to be treated. Patients in the West of the USA were also less likely to be treated ( OR = 0.76, P < 0.001) as were patients aged <65 or >84 years old ( P = 0.29). The predominant surgical approach was URS (65.2%), followed by ESWL (33.6%) and UL (1.2%). The use of URS increased over time, while the use of ESWL and UL declined. Women ( OR = 1.25, P < 0.001) were more likely to undergo URS . Patients in the South of the USA ( OR = 1.51, P < 0.001) and patients from ethnic minorities were more likely to undergo ESWL ( OR = 1.23, P = 0.03).Conclusions The surgical treatment of ureteric calculi changed significantly between 2001 and 2010. The use of URS expanded at the expense of ESWL and UL . Multiple inequalities existed in overall surgical treatment rates and in the choice of treatment; age, gender, ethnicity and geography influenced both whether patients underwent surgical intervention and the type of surgical approach used.