Presentation (CTI)

OBJECTIVES: Urolithiasis is a common urologic condition, involving lithotripsy typically performed as an outpatient procedure. Thulium fiber laser (TFL) and Holmium (HoYAG) lasers are widely used for treatment. Operating-room (OR) time is an outcome indicator of the complexity of the procedure. Studies have shown shorter OR-time for TFL vs. HoYAG; none employed nationally representative real-world data. Using the Premier healthcare data (PINC™ AI) (2021-2024), this study compared OR- time for TFL and HoYAG lasers and studied healthcare access variables that influence lithotripsy.
METHODS: CPT codes were used to identify patients undergoing lithotripsy; billing records determined laser type. Independent variables included age, gender, payor-type, race, ethnicity (socioeconomic); laser-type, admission status, Charlson’s comorbidity scores, Elixhauser scores, discharge-status (clinical); and facility size and teaching-status (facility). Outcome variable was OR-time (minutes), calculated using billing data. Descriptive analysis was followed by multivariate analysis. Generalized linear model (GLM), controlled clustered nature of data, with normal distribution and identity link was used.
RESULTS: Between 2021-2024, 137,194 unique encounters were identified, 99.6% (N=136,687) were outpatient; therefore, results discussed are outpatient. Given skewed nature of OR-time, data were divided at median (≤69 mins and ≥70mins). For OR-time ≤69 minutes, TFL and HoYAG showed similar durations; however, for OR-time ≥70 minutes, TFL was significantly shorter by 4.5 minutes (p<0.05). In GLM, after adjusting socioeconomic and clinical characteristics, and teaching-status, OR-time remained significantly less for TFL. Female gender reported 4.5 mins (p<0.05) shorter OR-times than males, elective procedures ~9 mins (p<0.05) longer than urgent procedures, and a point increase in Elixhauser score increased OR-time by 0.3 mins (p<0.05). Adjusting facility size further reduced OR-time difference. Overall, large facilities (> 500 beds) reported significantly longer OR-times.
CONCLUSIONS: In addition to laser type, facility size played a significant role in explaining OR-time difference, socioeconomic and clinical characteristics also influenced OR-time difference.