Pushing Stones Uphill: Why Patients Are Lost to Follow-Up After Uncomplicated Ureteroscopy

Abstract

Introduction:

We sought to determine the rate of and factors associated with patient nonadherence to prescribed follow-up after uncomplicated ureteroscopy.

Materials and Methods:

The records of 247 consecutive patients who underwent ureteroscopy at a tertiary referral center from November 2010 to February 2016 were reviewed. Bivariate and multivariate analyses were performed to determine the impact of demographic, procedural, socioeconomic, and environmental factors on the rate of compliance with secondary prevention counseling.

Results:

Forty-five patients (18.5%) were lost to scheduled follow-up for secondary prevention counseling after ureteroscopy. Lost to counseling rates were broad based and not associated with traditional predictors of poor follow-up such as age, gender, marital status, and distance traveled. On multivariate analysis, compared with those using commercial insurance, patients with Medicare (odds ratio [OR] for follow-up 0.48, 95% confidence interval [CI] 0.21, 1.1 p = 0.095) and Medicaid (OR for follow-up 0.25, 95% CI 0.1, 0.6, p < 0.001) were less likely to be adherent to prescribed follow-up.

Conclusions:

Nearly one in five patients will be lost to follow-up for secondary prevention counseling after ureteroscopy. Lack of follow-up may prevent the diagnosis of postoperative complications and limit the ability to counsel patients on stone prevention. Efforts to improve follow-up following ureteroscopy should focus on including more postoperative counseling in the preoperative period and a more individualized approach to specific patient populations, particularly those with a lower socioeconomic status.