Stone procedure complications are common, expensive

Despite their overall low risk, procedures to treat kidney stones lead to complications that require hospitalization or emergency care for one in seven patients, according to a recent study.

These complications are costly; patients who have an unplanned visit face an average cost of nearly $30,000, depending on the type of procedure and the subsequent care.

“Our findings provide a good starting point to understand why these complications are happening and how they can be prevented, because the costs to patients who suffer complications and to the health care system are substantial,” said lead author Charles D. Scales, Jr., MD, MSHS, of Duke University, Durham, NC.

Dr. Scales and his co-authors, who published their findings online in Surgery (2014; 155:769-75), analyzed the outcomes of more than 93,000 privately insured patients who underwent treatment for kidney stones. Procedures included shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy-the main interventions generating an estimated $10 billion in costs annually for kidney stone disease in the United States.

The authors included emergency department visits or hospital admissions within 30 days of the original procedure-a longer window of observation than had previously been studied.

According to the analysis, patients who had their surgery at hospitals that did high volumes of the procedure were much less likely to have complications.

When complications occurred, they were least common following shock wave lithotripsy, affecting 12% of patients. Those treated with ureteroscopy, the second most common procedure, had slightly more unplanned visits, with 15% of patients. Shock wave lithotripsy, however, had higher costs associated with the emergency visits, at more than $32,000.

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Costs for complications of nephrolithotomy were highest, averaging over $47,000 when an unplanned visit occurred.

Dr. Scales said further research is needed to understand why the different procedures resulted in different complication rates and costs, but noted that patients may be unprepared for complications arising from minimally invasive treatments.

“From the patient perspective, an unplanned emergency department visit or hospital admission after a low-risk ambulatory procedure is a significant event. Kidney stones are excruciatingly painful and primarily affect people who are of working age. These patients face not only the cost of treatment, but also the financial difficulties from time off work due to pain and treatment,” Dr. Scales said.

Dr. Scales said understanding why complications occur and how they can be avoided will be important next steps.

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