Christina Ching, MD, on predictors of follow-up after pediatric stone surgery

In this interview, Christina B. Ching, MD, shares key findings from the study, “Predictors of follow-up of pediatric stone patients after surgical intervention,” for which she served as the senior author. Ching is a clinical associate professor of pediatric urology at Nationwide Children’s Hospital in Columbus, Ohio.

Video Transcript:

Our primary outcome was to look at compliance with following up for a scheduled office visit after surgery. Then, we had 2 secondary outcomes, looking at completion of ordered imaging—post-op imaging specific to their kidney stones, like an ultrasound or CT scan—and then also completion of ordered 24-hour urine testing. What we found was pretty on par with the adult literature, which is what we were using, because that's really where the research has been done, is in the adult population. We found that about 75% of our patients came back for an office visit, which is on par with the adult literature, where it's anywhere from about 70% to 80% of adult studies reporting their retention of their patients after kidney stone surgery.

When we looked at what might be associated with poor follow-up or lack of a follow-up, we found that having public insurance and also being from a single-family home, those patients were less likely to follow-up. Interestingly, the patients that were more likely to follow-up were those patients that were seen and established within our urology clinic. So, the alternative is maybe they were seen in in the emergency room and taken to the operating room, as part of that encounter, or seen the emergency room [and] felt that they didn't need an emergent intervention, but from there, were scheduled for their surgical intervention, vs if they were actually seen in the urology clinic, because they were referred from another provider, or from the emergency room, were sent to the urology clinic to then subsequently have their surgery. We saw that being seen in the urology clinic led to a higher rate of those patients returning after their surgical intervention, pointing towards having established a relationship with those patients in a non-urgent or emergent setting helped predict and improve those patients coming back.

The other findings of a single-family home and public insurance can be metrics of lower socioeconomic status. That is interesting, because that data has been previously shown in the adult literature, of metrics of lower socioeconomic status being a potential metric for barriers to access to health care. In some of the adult literature looking at having public insurance, those patients ended up having a longer duration between when they presented with their kidney stone to actually undergoing surgery. Again, interesting to see that our data is actually following what has been previously reported, though in a different patient population.

For both obtaining the ordered imaging and the ordered urine studies, we similarly found that having public insurance and also being from a single-family home, that patient population was less likely to complete the imaging and the urine studies, again, confirming what we what we found from the office visits. One opportunity that we noticed was even ordering the urine studies; we had a higher rate of having appropriate orders in for post-op imaging and things like that. But, even though it's an AUA guideline to obtain urine studies, we found that just under about 70%, about 60%-65% of our patients had orders for urine studies. That identifies an opportunity for [us as] providers to follow the guidelines. Actually, the number of patients completing urine studies was also very low. That itself is just very interesting. Less than 50% of our patients went on to get the urine studies when they were even ordered in the first place. So, again, it identifies a potential opportunity to see, why is that? Why are we not ordering urine studies when maybe we should? But also, why is the completion rate so low? Our completion rate of appropriate imaging was about 80% so that's actually really encouraging. I mean, obviously we'd like everybody to get the appropriate follow-up imaging, but that was at least higher for compliance of obtaining the imaging than their urine studies.

This transcript was AI generated and edited by human editors for clarity.