PD50-08: Practice Patterns in the Surgical Management of Urolithiasis: Data from the AUA Quality (AQUA) Registry

Amy Showen*, Justin Ahn, San Francisco, CA, Raymond Fang, Cody Weiss, William Meeks, Linthicum, MD, Matthew Cooperberg, David Bayne, Tom Chi, San Francisco, CA

Introduction: Surgical management of urolithiasis is common, yet little national level data exists regarding current practice patterns. This study aimed to determine (1) practice rates for ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL), (2) secondary procedure rates, and (3) the impact of patient, provider, and practice characteristics on surgical practice patterns utilizing a urology-specific national database.

Methods: The AUA Quality (AQUA) Registry extracts patient data from participating urology practices from local electronic health records. Current Procedural Terminology and International Statistical Classification of Diseases 9/10 codes between January 1, 2014 and December 31, 2020 were used to identify urolithiasis procedures. Provider and practice characteristics were collected from the AUA Census. Patient, provider, and practice characteristics associated with primary and secondary procedures were evaluated using generalized linear models.

Results: 137,477 individuals with stone disease were treated surgically by 1,805 providers at 186 practices across the United States. 78,334 (56.9%) underwent URS, 52,645 (38%) underwent SWL, 6,209 (4.5%) underwent PCNL, and 288 (0.002%) underwent other open or laparoscopic surgical procedures. Of the 137,477 individuals treated surgically, 40,968 (29.8%) patients had a secondary procedure performed within one year of initial surgery, including 19,000 (24.3%), 19,191 (36.5%), and 2682 (43.2%) of those who underwent URS, SWL, and PCNL as their primary procedure, respectively. Patient, provider, and practice markers for poorer access to medical care were associated with undergoing PCNL or open/laparoscopic stone surgery (Table 1).

Conclusions: This national representation of practicing urologists demonstrates that while URS is the most common surgical stone procedure performed, more invasive surgery is associated with characteristics that may be a proxy for more complex stone disease or poorer access to medical care. AQUA data should be used by urologists to benchmark and improve practice patterns.

Source of Funding: University of California, San Francisco Resident Research Grant