Post-Surgical Imaging Patterns in Pediatric Nephrolithiasis: Opportunities for Improvement.

PURPOSE: Imaging following surgical intervention for nephrolithiasis is important to define surgical success as well as to ensure no silent obstruction. We assessed nationwide post-surgical imaging patterns in children undergoing ureteroscopy (URS) and shock wave lithotripsy (SWL).

METHODS: We reviewed the Thompson Reuters Marketscan™ Commercial Claims and Encounters database from 2007-2013 for children aged 1-18 years undergoing URS or SWL. Imaging exposure following index procedure within 90 days as a primary analysis and 180 days as a secondary analysis of the index procedure was assessed. Univariate and multivariate statistical analyses were performed to assess factors associated with receipt of post-surgical imaging.

RESULTS: A total of 4,251 children (1,647 SWL and 2,604 URS) met inclusion criteria. Post-surgical imaging was performed in 57.5% of the cohort, with a higher proportion of children receiving imaging following SWL as compared to URS (73% vs 47.8%, p < 0.001). Non-CT imaging modalities were most common following both URS (70.8%) and SWL (84.6%). Younger children, and those with complex medical conditions or complicated post-operative courses were more likely to receive follow-up imaging. CT imaging was more likely for older children and females. At 180 day follow-up, a total of 63% of the cohort received any imaging, again more common following SWL (77.0%) than URS (45.0%) CONCLUSION: Post-surgical imaging was not obtained in many children following surgery for nephrolithiasis and even less frequently following URS, with most follow-up imaging occurring within 90 days. Further work is needed to define appropriate post-surgical imaging practices in this population.