Surgeon, and Institution Characteristics Associated Surgical Preferences in the Pediatric KIDney Stone (PKIDS) Care Improvement Network

OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.