OBJECTIVES: Prior studies have reported that patients with longer indwelling stent duration prior to definitive stone treatment tended to have worse outcomes than those with shorter stent duration. The current study evaluates the effects of ureteral stent duration prior to percutaneous nephrolithotomy (PCNL) on health care utilization pre and post PCNL.

METHODS: A retrospective analysis was conducted using IBM MarketScan commercial data. Patients were included if they had a follow-up PCNL surgery within 6-months of stent placement. The time to PCNL surgery was calculated and categorized into two groups: ≤30 days and >30 days. Healthcare utilization included infectious complications (urinary tract infection, pyelonephritis, cystitis, sepsis), and medical costs adjusted to 2020 USD which were measured post stent placement till 3-months post PCNL surgery. A logistic regression model and a generalized linear model with gamma distribution was conducted to evaluate the association between delayed PCNL treatment and healthcare utilization controlling for patient demographics and comorbidities. The analysis was conducted using Instant Health Data platform.

RESULTS: The final cohort comprised of 317 patients. The mean time to PCNL after initial placement of the ureteral stent was 49.34 (±42.49) days. Among this cohort, 43.5% of patients underwent PCNL within 30 days of stent placement and 56.47% patients had PCNL surgery more than 30 days after stent placement. Patients who had a PCNL surgery after 30 days of stent placement were significantly associated with increased infectious complications (OR=1.98; p=0.0073), and medical costs (OR=1.33; p=0.0004). Average medical costs in the >30 days group were significantly higher than ≤30 days group ($42,470 vs $31,804; p=0.0004).

CONCLUSIONS: Patients who received a ureteral stent as their initial treatment and underwent PCNL more than 30 days after stent placement were associated with significant increases in healthcare utilization. These results are useful when considering health care resource utilization and prioritization of PCNL.