Presentation Authors: David Bayne*, SAN FRANCISCO, CA, Manint Usawachintachit, Bangkok , Thailand, Manuel Armas-Phan, SAN FRANCISCO, CA, David Tzou, Tucson, AZ, Scott Wiener, Marshall Stoller, Tom Chi, SAN FRANCISCO, CA
Introduction: Greater than 60% of counties in the United States have no urologists; does this impact stone patient management? Are stone clearance rates impacted by delays in getting to see an urologist? Our objective is to investigate the impact of delays to presentation to urology clinics and delays to surgery on need for repeat kidney stone interventions.
Methods: A retrospective review of the prospectively collected data from Sept 2015 to July 2018 was conducted to investigate the relationship between delay to seeing an urologist and delay to stone surgery. Data on unilateral stone size, patient age, race, gender, education level, BMI, ASA score, procedure type, mean income per zip code, distance from hospital, history of prior stone surgery, and English as a primary language were included. Univariate analysis was performed in R using Fisher&[prime]s Exact test and Welch Two Sample t-test. Multivariate analysis was performed using logistic regression. Statistical analysis was performed in R version 3.3.3.
Results: 368 patients with complete data available on need for multiple surgical procedures were identified. When evaluating patients with greater than 90 days between onset of symptoms to presentation to clinic, delays greater than 60 days to surgery, and history of prior stone surgery, only delays to clinic significantly predicted for need for multiple surgical procedures on multivariate analysis (p=0.009, OR 2.28). When controlling for all other variables, only unilateral stone burden >2cm (p < 0.001, OR 2.83), English as a second language (p=0.025, OR 2.55), and a history of prior stone surgery (p=0.042, OR 0.60) were significantly associated with delayed presentation to urology clinic >90 days on multivariate analysis.
Conclusions: Delays getting to an urologist predict for need for multiple surgical procedures for stone disease. English as a second language and large stone burden predict for delayed presentation to the urologist. There is need to focus efforts on improving access to care for patients who are vulnerable to delayed presentation to the urologist as it may improve quality of care, increase stone clearance rates, and reduce health care costs.
Source of Funding: NIH grant P20-DK-116193