Alexander Chiu, MD, Raymond Jean, MD, Kimberly Davis, MD, MBA, Kevin Pei, MD. Yale School of Medicine, Department of Surgery
Introduction: The benefit of prophylactic ureteral stents in colorectal surgery for diverticulitis has yet to be determined. Rationale for use include possible prevention and easier identification of ureteral injuries; others argue that the added time, costs, and risks of stent placement negate any potential benefits. Even among those who use stents, there is practice variability in selective versus universal use for colectomies. In light of this lack of consensus, our study evaluates trends in ureteral stent usage for all patients undergoing colectomy for diverticulitis and the factors influencing stent usage.
Methods: Data from the National Inpatient Sample (NIS), a weighted nationwide inpatient database, from 2000-2013 were analyzed. Stent placement was determined by patients having a concomitant ICD-9 CM procedure code for ureteral catheterization on the same day as a code for partial colectomy or anterior rectal excision for diverticulitis. Trends in intraoperative stent placement over this time period were evaluated and multivariate logistic regression was performed to evaluate the factors influencing stent placement.
Results: A total of 834,311 admissions nationally with a diagnosis of diverticulitis and undergoing either laparoscopic or open partial colectomy, or anterior rectal resection for diverticulitis were identified. Usage of ureteral stents has increased from 6.65% in 2000 to 16.22% in 2013. Rates of stent usage were consistently higher among laparoscopic surgery compared to open (17.3%-20.5% vs. 11.1-13.7%). Multivariate regression demonstrated factors influencing the use of stents included hospital geography in the Northeast (Midwest OR 0.57 95%CI [0.45,0.72], South OR 0.66 95% CI [0.53, 0.84], West OR 0.27 95% CI [0.20,0.36], all p<0.001), elective admission (OR 2.63 95% CI [2.38, 2.86], p<0.0001), hospital colectomy volume (High Volume OR 1.67 95% CI [1.37,2.05], Medium Volume OR 1.25 95% CI [1.07, 1.46], both p<0.01), and low Charlson Comorbidity Index (OR 1.28 95%CI [1.12, 1.47] p<0.001).
Conclusion: The use of prophylactic ureteral stents in surgery for diverticulitis has steadily increased since 2000, despite the lack of consensus on their overall benefits. There was wide variation in stent usage among regions of the country and hospitals of different colectomy volumes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78120
Program Number: P211
Presentation Session: Poster (Non CME)
Presentation Type: Poster
