To reveal barriers and opportunities to implement evidence for the management of pediatric kidney stone disease, we determined surgeon and institutional factors associated with preferences for the type of surgical intervention for kidney and ureteral stones.
We conducted a cross-sectional study of urologists participating in the Pediatric KIDney Stone Care Improvement Network (PKIDS) trial. Questionnaires ascertained strengths of urologists' preferences for types of surgery as well as characteristics of participating urologists and institutions. The outcome was the strength of preferences for ureteroscopy, shockwave lithotripsy, and percutaneous nephrolithotomy for four scenarios for which two alternative procedures are recommended by the AUA guidelines: A) 2 cm kidney stone, B) 9 mm proximal ureteral stone, C) 1.5 cm lower pole kidney stone, D) 1 cm non-lower pole kidney stone. Principal component analysis (PCA) was performed to identify unique clusters of factors that explain surgical preferences.
One hundred forty-eight urologists at 29 sites completed surveys. Stated preferences were highly skewed except for the choice between ureteroscopy and percutaneous nephrolithotomy for a 1.5 cm kidney stone. SWL ownership and local practice patters most frequently associated with the strength of surgeons' preferences for the type of surgery. PCA revealed that three clusters of stone, patient and heterogenous characteristics explained 30% of the variance in preferences.
There is wide variation in the strengths of preferences for surgical interventions supported by current guidelines that are partially explained by surgeon and institutional characteristics. These results reveal opportunities to develop strategies for guidelines that consider real-world drivers of care.
Urology. 2024 Mar 06 [Epub ahead of print]
Nicolas Fernandez, Jonathan S Ellison, Zi Wang, Jing Huang, David I Chu, Renea Sturm, Andrew A Stec, Ryan S Hsi, Wayland Wu, Caleb Nelson, Christina Ching, Brian Augelli, Matt Lorenzo, Jing Bi-Karchin, Gregory E Tasian
Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, WA., Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI., Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA., Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology. Chicago, IL., Mattel Children's Hospital, Dept of Urology, University of California, Los Angeles. CA., Division of Urology, Nemours Children's Health, Jacksonville, FL., Department of Urology. Vanderbilt University Medical Center. Nashville, TN., Division Pediatric Urology, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA., Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA., Kidney and Urinary Tract Center, Dept of Pediatric Urology, Nationwide Children's Hospital, Columbus OH., Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA., Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: .