Appropriateness Criteria for Ureteral Stent Omission following Ureteroscopy for Urinary Stone Disease

No AccessUrology PracticeHealth Policy1 May 2022Appropriateness Criteria for Ureteral Stent Omission following Ureteroscopy for Urinary Stone DiseaseThis article is commented on by the following:Editorial CommentaryEditorial Commentary Spencer C. Hiller, Stephanie Daignault-Newton, Ivan Rakic, Susan Linsell, Bronson Conrado, S. Mohammad Jafri, Ronald Rubenstein, Mazen Abdelhady, C. Peter Fischer, Elena Gimenez, Richard Sarle, William W. Roberts, Conrad Maitland, Rafid Yousif, Robert Elgin, Laris Galejs, Jeremy Konheim, David Leavitt, Eric Stockall, J. Rene Fontera, J. Stuart Wolf, John M. Hollingsworth, Casey A. Dauw, Khurshid R. Ghani, and for the Michigan Urological Surgery Improvement Collaborative Spencer C. HillerSpencer C. Hiller *Correspondence: Department of Urology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, Michigan 48109 telephone: 734-936-7030; FAX: 734-232-2400; E-mail Address: [email protected] https://orcid.org/0000-0001-8385-0040 Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Ivan RakicIvan Rakic Wayne State University School of Medicine, Detroit, Michigan More articles by this author , Susan LinsellSusan Linsell Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Bronson ConradoBronson Conrado Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , S. Mohammad JafriS. Mohammad Jafri Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Ronald RubensteinRonald Rubenstein Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Mazen AbdelhadyMazen Abdelhady Department of Urology, Detroit Medical Center, Detroit, Michigan More articles by this author , C. Peter FischerC. Peter Fischer Associates in Urology, Chelsea, Michigan More articles by this author , Elena GimenezElena Gimenez IHA-Urology, Ypsilanti, Michigan More articles by this author , Richard SarleRichard Sarle Sparrow Medical Group, Lansing, Michigan More articles by this author , William W. RobertsWilliam W. Roberts Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Conrad MaitlandConrad Maitland Sherwood Medical Center, Detroit, Michigan More articles by this author , Rafid YousifRafid Yousif Lansing Institute of Urology, Lansing, Michigan More articles by this author , Robert ElginRobert Elgin Michigan Institute of Urology, St. Claire Shores, Michigan More articles by this author , Laris GalejsLaris Galejs Michigan Institute of Urology, Howell, Michigan More articles by this author , Jeremy KonheimJeremy Konheim IHA-Urology, Ypsilanti, Michigan More articles by this author , David LeavittDavid Leavitt Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Eric StockallEric Stockall Capital Urological Associates, Okemos, Michigan More articles by this author , J. Rene FonteraJ. Rene Fontera Michigan Institute of Urology, Troy, Michigan More articles by this author , J. Stuart WolfJ. Stuart Wolf Dell Medical School, University of Texas, Austin, Texas More articles by this author , John M. HollingsworthJohn M. Hollingsworth Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Casey A. DauwCasey A. Dauw Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000302AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Introduction: To bridge the gap between evidence and clinical judgment, we defined scenarios appropriate for ureteral stent omission after uncomplicated ureteroscopy (URS) using the RAND/UCLA Appropriateness Method. We retrospectively assessed rates of appropriate stent omission, with the goal to implement these criteria in clinical practice. Methods: A panel of 15 urologists from the MUSIC (Michigan Urological Surgery Improvement Collaborative) met to define uncomplicated URS and the variables that influence stent omission decision making. Over 2 rounds, they scored clinical scenarios for appropriateness criteria (AC) for stent omission based on a combination of variables. AC were defined by median scores of 1 to 3 (inappropriate), 4 to 6 (uncertain) and 7 to 9 (appropriate). Multivariable analysis determined the association of each variable with AC scores. Uncomplicated URS cases in the MUSIC registry were assigned AC scores and stenting rates assessed. Results: Seven variables affecting stent decision making were identified. Of the 144 scenarios, 26 (18%) were appropriate, 88 (61%) inappropriate and 30 (21%) uncertain for stent omission. Most scenarios appropriate for omission were pre-stented (81%). Scenarios with ureteral access sheath or stones >10 mm were only appropriate if pre-stented. Stenting rates of 5,181 URS cases correlated with AC scores. Stents were placed in 61% of cases appropriate for omission (practice range, 25% to 98%). Conclusions: We defined objective variables and AC for stent omission following uncomplicated URS. AC scores correlated with stenting rates but there was substantial practice variation. Our findings demonstrate that the appropriate use of stent omission is underutilized. References 1. : Surgical management of stones: American Urological Association/Endourological Society guideline, PART I. J Urol 2016; 196: 1153. Link, Google Scholar 2. : EAU guidelines on interventional treatment for urolithiasis. Eur Urol 2016; 69: 475. Google Scholar 3. : Risks and benefits of postoperative double-J stent placement after ureteroscopy: results from the clinical research office of Endourological Society ureteroscopy global study. J Endourol 2017; 31: 446. Google Scholar 4. : Ureteral stent placement following ureteroscopy increases emergency department visits in a statewide surgical collaborative. J Urol 2021; 205: 1710. 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Google Scholar 29. : Is routine ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy for lower ureteral stones larger than 1 cm?Urol Res 2008; 36: 115. Google Scholar 30. : Limiting opioid overprescription after prostatectomy: how payer-provider collaboration can lead to improved patient safety and reimbursement. NEJM Catal Innov Care Deliv 2020; https://doi.org/10.1056/CAT.20.0140. Google Scholar Submitted December 6, 2022. Support: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is funded by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. CPF is supported by the National Institutes of Health. RE is supported by the National Institutes of Health, Howard Hughes Medical Institute and the Wellcome Trust. JMH has grant support from the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK12170901). Conflict of Interest: RS: Myovant Speakers Bureau, Genomic Health (past); RE: Johnson and Johnson; DL: Boston Scientific Corporation, Richard Wolf Medical; JSW: Ambu Corporation, Applaud Medical, Calyxo, Urology Times; CAD: Boston Scientific, AURIS Robotics; KRG: Boston Scientific, Coloplast, Storz, Olympus, Lumenis. Ethics Statement: Each MUSIC practice obtained an approval (Henry Ford IRB #8045, Wayne State University IRB #032112MR2E) or an exemption by the local Institutional Review Board for participation in the Collaborative. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byNarang G, Moore J, Wymer K, Chang Y, Lim E, Adeleye O, Humphreys M and Stern K (2023) Effect of Cannabidiol Oil on Post-ureteroscopy Pain for Urinary Calculi: A Randomized, Double-blind, Placebo-controlled TrialJournal of Urology, VOL. 209, NO. 4, (726-733), Online publication date: 1-Apr-2023.DiBianco J, Daignault-Newton S, Dupati A, Hiller S, Kachroo N, Seifman B, Wenzler D, Dauw C and Ghani K (2023) Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care UtilizationUrology Practice, VOL. 10, NO. 2, (163-169), Online publication date: 1-Mar-2023.Related articlesUrology Practice14 Mar 2022Editorial CommentaryUrology Practice1 May 2022Editorial Commentary Volume 9Issue 3May 2022Page: 253-263Supplementary Materials Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordsquality improvementurinary calculistentsureteroscopyAcknowledgmentsThe authors acknowledge the significant contributions of the clinical champions, urologists, administrators and data abstractors in each participating MUSIC practice (details can be found at www.musicurology.com), as well as members of the MUSIC Coordinating Center at the University of Michigan. We thank our patient advocates for their support, in particular Dennis Sitek, who provided valuable insight to our panelists. Lastly, we thank Michael Cher, MD, who forged the way with the Appropriateness Criteria for Active Surveillance of Prostate Cancer panel, for his guidance and expertise through this process.MetricsAuthor Information Spencer C. Hiller Department of Urology, University of Michigan, Ann Arbor, Michigan *Correspondence: Department of Urology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, Michigan 48109 telephone: 734-936-7030; FAX: 734-232-2400; E-mail Address: [email protected] More articles by this author Stephanie Daignault-Newton Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Ivan Rakic Wayne State University School of Medicine, Detroit, Michigan More articles by this author Susan Linsell Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Bronson Conrado Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author S. Mohammad Jafri Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Ronald Rubenstein Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Mazen Abdelhady Department of Urology, Detroit Medical Center, Detroit, Michigan More articles by this author C. Peter Fischer Associates in Urology, Chelsea, Michigan More articles by this author Elena Gimenez IHA-Urology, Ypsilanti, Michigan More articles by this author Richard Sarle Sparrow Medical Group, Lansing, Michigan More articles by this author William W. Roberts Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Conrad Maitland Sherwood Medical Center, Detroit, Michigan More articles by this author Rafid Yousif Lansing Institute of Urology, Lansing, Michigan More articles by this author Robert Elgin Michigan Institute of Urology, St. Claire Shores, Michigan More articles by this author Laris Galejs Michigan Institute of Urology, Howell, Michigan More articles by this author Jeremy Konheim IHA-Urology, Ypsilanti, Michigan More articles by this author David Leavitt Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Eric Stockall Capital Urological Associates, Okemos, Michigan More articles by this author J. Rene Fontera Michigan Institute of Urology, Troy, Michigan More articles by this author J. Stuart Wolf Dell Medical School, University of Texas, Austin, Texas More articles by this author John M. Hollingsworth Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Casey A. Dauw Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Khurshid R. Ghani Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Submitted December 6, 2022. Support: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is funded by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. CPF is supported by the National Institutes of Health. RE is supported by the National Institutes of Health, Howard Hughes Medical Institute and the Wellcome Trust. JMH has grant support from the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK12170901). Conflict of Interest: RS: Myovant Speakers Bureau, Genomic Health (past); RE: Johnson and Johnson; DL: Boston Scientific Corporation, Richard Wolf Medical; JSW: Ambu Corporation, Applaud Medical, Calyxo, Urology Times; CAD: Boston Scientific, AURIS Robotics; KRG: Boston Scientific, Coloplast, Storz, Olympus, Lumenis. Ethics Statement: Each MUSIC practice obtained an approval (Henry Ford IRB #8045, Wayne State University IRB #032112MR2E) or an exemption by the local Institutional Review Board for participation in the Collaborative. Advertisement PDF downloadLoading ...