Variation and Correlation in Postoperative Imaging After Shockwave Lithotripsy and Ureteroscopy by Treatment Modality: Results of a Statewide Clinical Registry

OBJECTIVE To understand how patient, practice/urologist-level factors impact imaging after ureteroscopy (URS) and shockwave lithotripsy (SWL). METHODS Using the Reducing Operative Complications from Kidney Stones (ROCKS) clinical registry from the Michigan Urological Surgery Improvement Collaborative (MUSIC), we identified patients undergoing URS and SWL between 2016-2019. Frequency and modality of 60-day postoperative imaging was assessed. We made bivariate comparisons across demographic/clinical data and assessed provider/practice-level imaging rate variation. We assessed correlation between imaging use within practices by treatment modality. Multivariable logistic regression controlling for prac-tice/urologist variation was used to adjust for group differences. RESULTS 14,894 cases were identified (9621 URS, 5273 SWL) from 33 practices and 205 urologists. Overall postoperative imaging rate was 49.1% and was significantly different following URS and SWL (36.3% vs 72.4%, P<0.01). Substantial practice variation was seen in rates following URS (range 0-93.1%) and SWL (range 36-95.2%). Odds of postoperative imaging by practice varied signifi-cantly (range 0.02-1.96). Moderate postoperative imaging correlation for URS and SWL (0.7, P<0.001) was seen. No practice had significantly higher odds of post-URS imaging. There was increased odds of postoperative imaging for SWL modality, larger stones and renal stones. CONCLUSION Imaging rates after URS are almost half the rate for SWL with wide variation, underscoring uncer-tainty with how postoperative imaging is approached. However, practices who have higher post-URS imaging rates also image highly after SWL. Increased patient complexity and renal stone loca-tion drive imaging following URS. UROLOGY 168: 79-85, 2022. (c) 2022 Elsevier Inc.