No-show after extracorporeal shock wave lithotripsy treatment in endourology clinic: Can we build a typical patient profile?

Objectives: Patients "no-show" in outpatient clinics is a worldwide challenge. Healthcare providers and patients suffer from negative impacts that include increased expenditure, clinical management ineffectiveness, and decreased access to care. This study aims to evaluate no-show rate among extracorporeal shock wave lithotripsy patients visiting endourology clinic and to identify the demographic and clinical predictors of no-show.

Methods: A cross-sectional and historical cohort study using electronic medical records. We included 790 patients aged >18 years old referred for endourology clinic following shock wave lithotripsy during 2010-2017 at Hadassah Medical Center in Israel. We predicted no-show rate following shock wave lithotripsy by various patient characteristics by a multivariate logistic regression model.

Results: Overall, 291 (36.8%) patients did not arrive for postoperative clinic. Of these, 91 (11.52%) patients referred to Emergency Department. Patients who were younger in age (odds ratio 1.49, 95% confidence interval 1.08-2.04), patients who underwent hospitalization ≥3 days (odds ratio 1.63, 95% confidence interval 1.11-2.41) and patients who had undergone a stent-free shock wave lithotripsy (odds ratio 5.71, 95% confidence interval 2.40-13.57) were significantly associated with higher no-show rate. Larger stone size was associated with reduction in no-show rate with every millimeter increase of stone diameter was associated with a reduction of 6.1% probability for no-show (odds ratio 0.94, 95% confidence interval 0.89-0.99).

Conclusions: Predicting patients' characteristics and no-show patterns is necessary to improve clinical management efficiency, access to care, and costs. We showed that patients who were younger, patients who underwent stent-free shock wave lithotripsy, patients who had a smaller stone, and patients who underwent a longer hospitalization were more prone to miss their appointment. Paying attention to the characteristics of individual patients may assist in implementing intervening program of patient scheduling.