ABSTRACT
Introduction & Objective: During the COVID-19 pandemic, limits on elective surgical care were instituted by hospitals to preserve resources. Additionally, patients' desire to limit health care contact may impact surgical decision making.We aimed to understand how institutional pressures and patient preference affected the delivery, choice and outcome of ambulatory surgical care for urinary stone disease during the COVID-19 pandemic. Methods: Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) that maintains a prospective clinical registry of ureteroscopy (URS) and shockwave lithotripsy (SWL) cases. Using this registry, we categorized all cases by time frame, defining July 1st - December 31st 2019 as preCOVID (PC), March 16th - June 15th 2020 as duringCOVID (DC) and June 16th - September 15th 2020 as afterCOVID (AC). Patients in each cohort were characterized across a range of sociodemographic and clinical factors. We assessed changes in procedure choice (URS vs SWL), procedure acuity (elective vs emergent), and outcomes (ED visit and hospitalization within 30 days of surgery). Results: 6375 cases were identified, 4513 URS and 1862 SWL. PC consisted of 3310 cases (2238 URS and 1072 SWL), DC consisted of 1141 cases (888 URS and 253 SWL) and AC consisted of 1924 cases (1387 URS and 537 SWL). A higher proportion of URS cases were performed DC compared to PC and AC (77.8% vs 67.6% vs 72.1%, p < 0.001, respectively). A higher percentage of emergent cases in DC compared to PC and AC (21.8% vs 13.7% vs 15.3%, p < 0.001, respectively). Significantly more cases in DC compared to PC and AC were prestented, had positive UA/urine culture, ureteral stones, had hydronephrosis, were stented and had longer stent dwell time. ED visits and unplanned hospitalizations were not significantly different. Conclusions: The COVID-19 pandemic resulted in a lower overall stone treatment rates and higher proportions of URS compared to SWL. Significantly more emergent cases for ureteral stones with positive UA/urine cultures and evidence of obstruction were performed duringCOVID with higher stent placement rates and longer stent dwell times. These data pointing towards preference for higher intensity or acuity cases without differences in unplanned healthcare encounters. (Table Presented).
ABSTRACT
INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic, limits on elective surgical care were instituted by hospitals to preserve resources. Additionally, patients' desire to limit health care contact may impact surgical decision making. We aimed to understand how institutional pressures and patient preference affected the delivery, choice and outcome of ambulatory surgical care for urinary stone disease during the COVID-19 pandemic. METHODS: Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) that maintains a prospective clinical registry of ureteroscopy (URS) and shockwave lithotripsy (SWL) cases. Using this registry, we categorized all cases by time frame, defining July 1st - December 31st 2019 as preCOVID (PC), March 16th - June 15th 2020 as duringCOVID (DC) and June 16th - September 15th 2020 as afterCOVID (AC). Patients in each cohort were characterized across a range of sociodemographic and clinical factors. We assessed changes in procedure choice (URS vs SWL), procedure acuity (elective vs emergent), and outcomes (ED visit and hospitalization within 30 days of surgery). RESULTS: 6375 cases were identified, 4513 URS and 1862 SWL. PC consisted of 3310 cases (2238 URS and 1072 SWL), DC consisted of 1141 cases (888 URS and 253 SWL) and AC consisted of 1924 cases (1387 URS and 537 SWL). A higher proportion of URS cases were performed DC compared to PC and AC (77.8% vs 67.6% vs 72.1%, p <0.001, respectively). A higher percentage of emergent cases in DC compared to PC and AC (21.8% vs 13.7% vs 15.3%, p <0.001, respectively). Significantly more cases in DC compared to PC and AC were prestented, had positive UA/urine culture, ureteral stones, had hydronephrosis, were stented and had longer stent dwell time. ED visits and unplanned hospitalizations were not significantly different. CONCLUSIONS: The COVID-19 pandemic resulted in a lower overall stone treatment rates and higher proportions of URS compared to SWL. Significantly more emergent cases for ureteral stones with positive UA/urine cultures and evidence of obstruction were performed duringCOVID with higher stent placement rates and longer stent dwell times. These data pointing towards preference for higher intensity or acuity cases without differences in unplanned healthcare encounters.
ABSTRACT
Objective: There has been a rapid expansion of video visits, a form of telehealth, with the COVID-19 pandemic;however, little is known about the feasibility or benefits of video visits for patients seeking male infertility care. Herein we summarize a single institution’s experience using video visits to manage infertility prior to the COVID-19 pandemic. Specifically, we evaluate the number of patients engaging in video visits for the first time, and the patient resources saved by forgoing in-person appointments. Design: Retrospective case series of patients undergoing video visits for follow-up of male-infertility care. Materials and Methods: We identified all video visits performed at our institution between August 21, 2017 and March 17, 2020. We included men seen for male infertility by a single urologist. We used chart review to collect patient demographic information including age, primary language, race, and occupation. Patients were identified as blue collar versus white collar workers with respect to their engagement in manual labor. We determined whether patients had a prior video visit completed at our institution. We used Google MapsTM to calculate round-trip driving distance and time saved based on patients’ city of residence. Driving costs saved were calculated by using American Automobile Association’s cost estimate of >source.59/mile. Finally, salaries were used to estimate wages lost if taking a half or full day off to attend an in-person clinic visit. Results: 70 male infertility video visits were completed by 56 patients. Median age of patients was 36 years old (range 20-56), 96% identified preferred language as English, and 78% self-identified as white. There were a total of 49 unique occupations among the 56 men. 32% were blue collar workers and 68% were white collar workers. For 55 of 56 patients, this study period represented their first use of video visits in our health system. Video visits allowed patients to save a median of 80 miles (interquartile range 46-244) and 97 minutes (IQR 64-250) of travel per visit. This resulted in a median of $47 (IQR 27–144) of driving costs saved per visit. By not having to miss a half or full day of work, patients potentially avoided a median of $102 (IQR $69 – 133) to $205 (IQR $137 – 266) in lost wages, respectively. Total median savings per patient ranged from $149 (half day off) to $252 (full day off). Median salary of our cohort was $51,331. In total, 70 video visits saved 56 patients 11,646 miles and 12,070 minutes in travel. Total estimated savings to patients was $14,539 (half day off) to $22,206 (full day off). Conclusions: Video visits are a feasible option for follow-up infertility care and are a patient-centric modality that reduces travel and financial burdens. 98% of patients were first-time video visit users suggesting that men are amenable to using video visits for male infertility care. Calculated cost savings may have underestimated total expenses as we did not account for meals, parking fees and other expenses incurred by traveling for an in-person appointment.
ABSTRACT
Objective: While the COVID-19 pandemic has resulted in a rapid expansion of telehealth services, it remains unknown how video visits, a form of telehealth, can be used to treat male infertility. We sought to evaluate what infertility diagnoses were see and how they were managed through telehealth. Herein we summarize a single institution’s experience with video visits for male infertility prior to COVID-19. Design: Retrospective case series of patients with male infertility managed via video visits. Materials and Methods: We identified video visits completed at our institution between August 21, 2017 and March 17, 2020 for male infertility. All men had a previous in-person examination. We collected patient demographic and referral information, grouped primary diagnoses, categorize what management steps were taken, and determined whether in-person examinations were needed within 90 days. Results: 70 video visits were completed by 56 men. The median age was 36 years (interquartile range 32 - 40), 78.5% were white, and most patients were referred by their primary care provider or their partner’s reproductive endocrinologist (47% and 33%, respectively). Most men were diagnosed with endocrinologic (29%) or anatomic (21%) contributors to infertility. See Table1A for full diagnostic categories. 73% of video visits involved reviewing results such as semen analysis and hormonal testing. 30% of visits involved counseling for assistive reproductive technologies (ART) and, in 25% of visits, hormonally active medications were prescribed. See Table1B for all management categories. There were only two in-person visits within 90 days after a video visit, both of which were planned post-operative visits. [Formula presented] Conclusions: Video visits can be used with established patients to manage a broad spectrum of diagnoses that contribute to male infertility. In the short-term, these visits are serve as substitutes for clinic visits without resulting in additional in-person encounters.