Improving Kidney Stone Intervention Follow-up Care

_{Many patients skip follow-up visits after kidney stone surgery. A QI project aims to change that.}

The incidence and prevalence of pediatric kidney stones have been rising rapidly in the United States, particularly in the South. A Children’s of Alabama study found an increase of 84.4% over 15 years, with an average increase of 16.1% every three years.¹ Recurrence rates are also high, with about half of children experiencing a recurrence within five years.²

The economic costs are significant, noted Children’s of Alabama pediatric urologist Carmen Tong, D.O. One study found overall costs for 8,498 patients of $117.1 million.³ Medical costs, however, don’t take into consideration the intangible human capital loss such as lost workdays for caregivers and extra childcare costs, Tong said.

Some of this cost is due to high recurrence rates, she said, but also to issues relating to pain and infections after intervention.

Current guidelines call for follow-up imaging four to six weeks after surgery to confirm all stones are gone and discuss preventive measures. However, Tong’s review of 130 patient charts found that nearly half didn’t return for that follow-up visit. Those findings echo other studies in larger populations.⁴

That prompted a new quality improvement project to identify socioeconomic factors that could predict adherence with postoperative follow-up, she said. “We’ve noted that parents come back with their patients because of pain, poor pain control or issues with infection,” but not for routine follow-up if the child is doing well, Tong said.

The project will examine barriers and boost resources and education for families. “Enhanced communication can hopefully limit complications like inadequate pain control and infections, which currently prompt some visits,” Tong said. Her team will partner with Nationwide Children’s Hospital in Columbus, Ohio, to examine the influence of a multi-institutional, incentivized study on follow-up adherence versus no incentive.

“We want to improve our communication and education to this population so they’re better equipped to provide the follow-up care their child needs,” she said.

1. [1] Zhang SY, Collingwood JD, Fujihashi A, He K, Oliver LA, Dangle P. Incidence of Emergency Department Presentations of Symptomatic Stone Disease in Pediatric Patients: A Southeastern Study. Cureus. 2022;14(11):e30979. Published 2022 Nov 1. doi:10.7759/cureus.30979 ↩︎
2. [1] Tasian GE, Kabarriti AE, Kalmus A, Furth SL. Kidney Stone Recurrence among Children and Adolescents. J Urol. 2017;197(1):246-252 ↩︎
3. [1] Sturgis MR, Becerra AZ, Khusid JA, et al. The monetary costs of pediatric upper urinary tract stone disease: Analysis in a contemporary United States cohort. J Pediatr Urol. 2022;18(3):311.e1-311.e8. doi:https://doi.org/10.1016/j.jpurol.2022.02.019 [1] Ellison JS, Merguerian PA, Fu BC, et al. Postoperative Imaging Patterns of Pediatric Nephrolithiasis: Opportunities for Improvement. J Urol. 2019;201(4):794-801. doi:10.1016/j.juro.2018.10.002 ↩︎
4. Ellison JS, Merguerian PA, Fu BC, et al. Postoperative Imaging Patterns of Pediatric Nephrolithiasis: Opportunities for Improvement. J Urol. 2019;201(4):794-801. doi:10.1016/j.juro.2018.10.002 ↩︎