Point-of-care ultrasound is an accurate, time-saving, and cost-effective modality for post-operative imaging after pyeloplasty. Issue 4 (August 2020)

• Record Type: Journal Article
• Authors: Villanueva, Jeffrey; Pifer, Benjamin; Colaco, Marc; Fox, Janelle; Chaudhry, Rajeev; Schneck, Francis; Cannon, Glenn
• Is Part Of: Journal of pediatric urology. Volume 16:Issue 4(2020)
• Page Start: 472.e1
• Page End: 472.e6
• Publication Date: 2020-08
• Subjects: Pyeloplasty -- Point-of-care ultrasound -- Post-operative imaging -- Healthcare efficiency; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2020.05.156
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Background: Dismembered pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). Although the frequency and timing of follow up imaging after pyeloplasty is variable, renal ultrasound (RUS) is commonly utilized. With minimal training, point-of-care ultrasound (POCUS) can be easily performed by a urologist during a post-operative visit. Objective: Our hypothesis is that POCUS is an accurate, time-saving, and cost-effective alternative to a complete retroperitoneal ultrasound (CRUS) performed by the Radiology Department after pyeloplasty. Study design: The clinical records of all children who underwent pyeloplasty (by any method) over a 12 month period at our institution were retrospectively reviewed. The exact timing and method (POCUS vs. CRUS) of follow up imaging was surgeon-dependent. Statistical analysis was performed to compare the time and cost of POCUS vs. CRUS. The clinical course of each patient who had each type of imaging was assessed. Results: A total 45 patients were included in this analysis. Over a mean follow up period of 29 months, a total of 73 CRUS and 67 POCUS were performed. Each CRUS on average added 2 h to each patient's healthcare encounter. Had the 73 CRUS been performed as POCUS instead, this would have corresponded to $83, 751 less charges to payers. There was no difference in the rate of the detection of worsening, stable, or improved hydronephrosis (HN) between either modality ( p > 0.05). The recommended follow up time for observed HN was no different between CRUS and POCUS ( p > 0.05). Children with worsening HN on POCUS underwent functional studies without confirmatory CRUS. Interestingly, two patients had metachronous, contralateral UPJO discovered during post-operative imaging. These were both discovered by POCUS. Nineteen (42%) patients who had attended at least one post-operative visit were eventually loss to follow-up. This occurred exclusively in those who did not have worsening ultrasound ( p < 0.01). There was no difference in the loss to follow-up after POCUS (8) or CRUS (12) ( p > 0.05). Conclusions: POCUS performed by a urologist is an accurate assessment of HN after pyeloplasty with time and cost savings to compared to a CRUS performed by a radiologist. POCUS is not associated with any difference in rate of detection of worsening HN or rate of loss to follow up. Summary Table Clinical characteristics based on type of follow up renal ultrasound after pyeloplasty Point-of-care ultrasound Complete retroperitoneal ultrasound Cohort descriptive Statistics n (% or SD) n (% or SD) Total ultrasounds Performed 67 (48) 73 (52) Public insurance 25 (34) 22 (33) Age (mos) 72 (65)∗ 107 (76)∗ Mean time (min) attributable to the Radiology Department 0∗ 122 (101)∗ 2018 hospital charge ($) 273 1639 Interval result in hydronephrosis Worsened 5 (7.5) 6 (8.2) No change 11 (16.4) 11 (15.1) Improved 51 (76.1) 56 (76.7) Preceded an unplanned procedure 5 (10) 1 (1) Follow-up nuclear medicine study performed 6 (9) 5 (7) Legend ∗ p < 0.05.