Abstract | November 18, 2023

Community Income and Kidney Stone Surgical Delay

Avaneesh Kunta, BS, Medical Student, 2nd Year, University of Central Florida College of Medicine, Orlando, FL

Sudarshan Srirangapatanam, BA, Medical Student, 4th Year, University of Central Florida College of Medicine, Orlando, FL; Caroline Baughn, BS, Medical Student, 4th Year, University of Central Florida College of Medicine, Orlando, FL; Hubert S. Swana, MD, Pediatric Urology, Associate Professor, Orlando Health/Arnold Palmer Hospital, Orlando, Florida

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to examine the effect of the federal poverty level (FPL), income level, and food stamp usage on surgical delays in at-risk populations.
  2. Upon completion of this lecture, learners should be better prepared to identify communities that may face higher risks of surgical delays to improve patient kidney stone outcomes.

Background: Surgical delay is associated with poor treatment outcomes. Socioeconomic status (SES) is shown to contribute to surgical delay. The precise effect of community income and surgical outcomes at large have been underexplored. In this study, we explored the association between community-level risk factors and surgical delay for kidney stone procedures in an acute to sub-acute setting.

Methods: Patient data from the Healthcare Cost and Utilization Project (HCUP) dataset between 2016-2020 was indexed with community economic data from the Agency for Healthcare Research and Quality’s (AHRQ) dataset based on zip code tabulation areas (ZCTAs). The median time to surgery (in days) was calculated for each ZCTA. A MANOVA analysis was conducted to identify predictors for increased surgical delay. All statistical analysis was conducted using R version 4.0.

Results: 7,401 patients were identified within 304 Florida ZCTAs. Communities with a higher prevalence of patients <1.37 of the federal poverty level (FPL) were significantly associated with increased surgical delay (slope=1.64, p<0.001). Conversely, communities with a higher prevalence of patients >4.00 FPL had significantly decreased surgical delay (slope=-3.42, p<0.001). Communities with FPL between 1.38-1.99 and 2.00-3.99 showed a slight positive association with time to surgery but were not statistically significant (slope=0.89, p>0.05). Increased median household income and decreased percentage of patients on food stamps showed a statistically significant trend towards decreased surgical delay (p<0.05).

Conclusion: This study highlights the influence of economic context on kidney stone surgical delay. Communities that have a large proportion of low-income kidney stone patients are at increased risk for surgical delay. These delays may exacerbate kidney stone outcomes and lead to further complications and the need for more invasive treatments. This data may help tailor Florida health policies and interventions.

References and Resources

  1. Ginsburg KB, Curtis GL, Patel DN, et al. Association of surgical delay and overall survival in patients with t2 renal masses: Implications for critical clinical decision-making during the covid-19 pandemic. Urology. 2021;147:50-56. doi: 10.1016/j.urology.2020.09.010.
  2. Hughes T, Ho HC, Shariat SF, Somani BK. Where do urologists stand in the era of novel coronavirus-2019 disease. Curr Opin Urol. 2020;30(4):610-616. doi: 10.1097/mou.0000000000000786.
  3. Bayne, D., Maru, J., Srirangapatanam, S., Hicks, C., Neuhaus, J., Scales, C., Chi, T., & Stoller, M. (2023). Effects of Delayed Surgical Intervention Following Emergency Department Presentation on Stone Surgery Complexity. Journal of endourology, 37(6), 729–737. https://doi.org/10.1089/end.2022.0843.
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