Ureterorenoscopy in a tertiary referral hospital: is level of care associated with the outcome?

Röell, S. (Sabine) (2015) Ureterorenoscopy in a tertiary referral hospital: is level of care associated with the outcome? thesis, Medicine.

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Abstract

Background: ureterorenoscopy is a safe and effective treatment option for stones in the urinary tract. Previous research suggests that patients have better outcome for ureterorenoscopy when this is performed in high case volume centres. However, in tertiary referral centres it might be that more difficult cases are treated, referring to both patient and stone characteristics. The urology department of the AMC is a tertiary referral centre for urolithiasis, and provides both secondary and tertiary care in this field. The aim of this study is to evaluate the outcome of ureterorenoscopy in this tertiary referral centre and to see if the level of care has a relationship with the outcome. Patients and methods: since January 2010 the AMC has prospectively collected data on the ureterorenoscopy patients in collaboration with the Clinical Research Office of the Endourological Society (CROES) ureterorenoscopy global study. We evaluated the outcome in terms of patient characteristics, success rate and complications in the AMC and compared this with the CROES URS Global Study as baseline normal population. Depending on the referrer - we then stratified the outcome based on level of care: secondary or tertiary. Using the chi-square test, the URS outcome was compared. With logistic regression the relationship between level of care and outcome in terms of stone free and complication rate was evaluated. Results: between January 2010 and May 2015, 748 ureterorenoscopies for urolithiasis were performed in the AMC. From January 2010 till October 2012 11885 ureterorenoscopies were performed in 114 different centres worldwide in the CROES URS Global Study. Compared to the CROES population, the AMC patients had more comorbidity, a lower stone free rate (68.9% vs. 85.6%) and a higher complication rate. Stratifying the outcome for level of care showed a lower stone free rate for the tertiary care group than for the secondary care group (65.6% vs. 72%) but this was not statistically different (p=0.174). Complication rates were comparable between these two groups. Logistic regression analysis showed no relationship between ureterorenoscopy outcome and the level of care of the patient. Conclusion: patients in this tertiary referral centre have more comorbidity, a lower stone free rate and a scarcely higher complication rate than the CROES URS Global Study. However, we found no relationship between the outcome of and level of care given.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Meer, Drs. G.T. Van der M.D.
Supervisor name:	Daily supervisor: and Kamphuis, Drs. G.M. M.D. and Location: Academisch Medisch Centrum (AMC), Amsterdam
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1315

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