Pain is the most common reason for emergency department (ED) visits in the 30 days following ureteroscopy, according to a 6-month review of cases conducted at Scott and White Medical Center, Temple, TX.
Among 47 ED visits within 30 days of elective ureteroscopy over the 6-month span, pain was the presenting complaint in about 60% of patients, reported Luke Machen, MD, at the AUA annual meeting. The type of pain medication prescribed at discharge did not affect the likelihood of an ED visit for pain.
Better counseling about the discomfort to be expected with stents and the management of expectations may reduce the rate of ED visits for pain, although this hypothesis remains to be proved, said Dr. Machen, who worked on the study with Marawan El Tayeb, MD, and colleagues.
“I think some of it is it just hurts a little more than they expect, and if we were better about counseling and the patients know what’s coming, we may see a decrease in ED visits,” he said.
A retrospective chart review was conducted from July 1, 2015 to Dec. 31, 2015 to identify patients who returned to the ED within 30 days of elective ureteroscopy. The 30-day endpoint was chosen because hospital reimbursement for readmissions within 30 days is reduced as part of quality improvement measures instituted under the Affordable Care Act and the Centers for Medicare & Medicaid Services.
A total of 330 ureteroscopies were performed over the 6 months. Twenty-seven patients (57.4%) were pre-stented at an average of 11.5 days preoperatively. All patients were discharged with a stent in place, 26 (55.3%) of whom had a string attached with instructions for removal at home. Forty patients (85.1%) were discharged with either codeine/acetaminophen (Tylenol #3) or tramadol (Ultram) for pain control.