Pd47-12 Does Anesthesia Type Matter in Shockwave Lithotripsy?

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) IV (PD47)1 May 2024PD47-12 DOES ANESTHESIA TYPE MATTER IN SHOCKWAVE LITHOTRIPSY? Sami E. Majdalany, Kangli Chen, Stephanie Daignault-Newton, David A. Leavitt, Khurshid R. Ghani, Casey A. Dauw, Naveen Kachroo, and for the Michigan Urological Surgery Improvement Collaborative Sami E. MajdalanySami E. Majdalany , Kangli ChenKangli Chen , Stephanie Daignault-NewtonStephanie Daignault-Newton , David A. LeavittDavid A. Leavitt , Khurshid R. GhaniKhurshid R. Ghani , Casey A. DauwCasey A. Dauw , Naveen KachrooNaveen Kachroo , and for the Michigan Urological Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1097/01.JU.0001008652.62443.0a.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have shown a benefit for general anesthesia (GA) in shockwave lithotripsy (SWL) however there are no specific anesthesia recommendations in the AUA guidelines. We evaluated statewide practice patterns and predictors for use of GA over sedation in SWL and compared whether anesthesia type affected outcome and patient-reported outcomes (PRO). METHODS: Adult patients undergoing SWL between 2016-2023 were identified using the Michigan Urological Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones prospectively collected clinical registry. Outcome measures included stone-free rates (SFR), complications and emergency department (ED) visits. PRO data, available beginning in 2020, included patient pain scores (PROMIS Pain Intensity and Pain Interference) and overall treatment satisfaction (ICIQ-S) assessed pre- and post-operatively (7-10 days and 4-6 weeks). A logistic mixed model was used to assess anesthesia type by patient and pre-surgery factors with a random effect for provider within practice and report the Intra-class correlation (ICC). RESULTS: Among 13,182 cases identified from 36 practices, wide variation in GA utilization was noted (Figure 1). During this study period, numbers in receipt of SWL declined but GA rates increased (22% to 55%). Preoperative mean stone diameter was the only clinical predictor for GA use (OR 1.04, 95%CI 1.02-1.06, p<0.001). ICC was 79% indicating very strong within practice patterns for GA utilization highlighting the influence of provider choice in this model. There were no significant differences in outcomes between patients receiving general anesthesia and sedation: complication rates (0.13% vs 0.22%, p=0.3), ED visits (3.6% vs 3.4%, p=0.5), or 60-day SFR (40% vs 39%, p=0.09). PRO data from 273 SWL surgeries showed no significant difference in pre- or post-operative pain intensity or interference between those receiving GA or sedation and no evidence of a difference in treatment satisfaction. CONCLUSIONS: Wide variation in GA use over sedation at SWL was identified, primarily driven by the provider, with increasing rates over time. Anesthesia type did not significantly affect patient safety, outcome or patient experience questioning the role of GA in SWL patients. Download PPT Source of Funding: Blue Cross Blue Shield of Michigan © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e985 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sami E. Majdalany More articles by this author Kangli Chen More articles by this author Stephanie Daignault-Newton More articles by this author David A. Leavitt More articles by this author Khurshid R. Ghani More articles by this author Casey A. Dauw More articles by this author Naveen Kachroo More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...