Infectious Complications, Healthcare Resource Use, and Medical Costs Associated with Delays in Percutaneous Nephrolithotomy Among Patients with Stone Disease and Ureteral Stent Placement.

The relationship between ureteral stent duration before percutaneous nephrolithotomy (PCNL) and infectious complications, admissions, imaging, and medical costs was evaluated. Patients who underwent PCNL within 6 months of ureteral stent placement were identified from commercial claims, categorized by time to treatment (0-30, 31-60, and >60 days), and followed 1-month post-PCNL. The effect of delayed treatment on inpatient admissions, infectious complications (pyelonephritis/sepsis), and imaging utilization was evaluated with logistic regression. A generalized linear model evaluated the effect of delayed treatment on medical costs. Among 564 patients with PCNL and meeting the inclusion criteria (mean age 50; 55% female; 45% from South), mean (standard deviation) time to surgery was 48.8 (41.8) days. Less than half (44.3%;  = 250) underwent PCNL within 30 days of ureteral stent placement, 27.0% ( = 152) between 31 and 60 days, and 28.7% ( = 162) >60 days. Time to PCNL was significantly associated with inpatient admissions (>60 ≤30 days odds ratio [OR] 1.97, 95% confidence interval [CI] 1.29-3.01,  = 0.0016), infectious complications (>60 ≤30 days OR 2.43, 95% CI 1.55-3.81,  = 0.0001), imaging utilization (31-60 ≤30 days OR 1.56, 95% CI 1.02-2.38,  = 0.0383; >60 ≤30 days OR 2.01, 95% CI 1.31-3.06,  = 0.0012), and medical costs (31-60 ≤30 days OR 1.27, 95% CI 1.08-1.49,  = 0.0048; >60 ≤30 days OR 1.46, 95% CI 1.24-1.71,  < 0.0001). Compared with PCNL within 30 days, patients undergoing PCNL >30 days after ureteral stent placement had increased likelihood of infectious complications, resource use, and medical costs. These results may inform health care resource utilization and PCNL prioritization.