Abstract：
Introduction and Objective: In early 2020, as the SARS-Cov-2 (COVID-19) pandemic progressed, many institutions limited nonurgent surgical care. This coincided with a decade-long trend of increasing percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) and decreasing shock wave lithotripsy (SWL) for surgical management of urolithiasis. Herein, we evaluate temporal stone surgery rates and surgeon volumes in the Medicare population and suggest how COVID-19 contributed to them. Methods: Retrospective analysis was conducted using the \"Medicare Physician & Other Practitioners\" database containing data from January 2013 to December 2021. Adult patients who underwent stone surgery were included. We evaluated surgeon characteristics and changes in case volumes over time adjusted for population. Results: In 2013, urologists performed 68,910 stone surgeries: SWL 42,903 (62%); URS 25,321 (37%); PCNL 686 (1%). Over the next 8 years, there was an average annual increase in URS (+13%) and PCNL (+13%) and decrease in SWL (-2%). In 2020, there was a 14% reduction in all stone cases: SWL (-25%); URS (-6%); PCNL (-8%). By 2021, case volumes recovered to pre-2020 levels, though SWL remained low: SWL 33,974 (34%); URS 64,541 (64%); PCNL 1764 (2%). From 2013 to 2021, the number of urologists performing SWL decreased (1718 to 1361) while URS and PCNL providers doubled (1,347 to 2,914 and 28 to 76, respectively). Conclusions: From 2013 to 2021, there was an increase in URS and PCNL and a decrease in SWL in the US Medicare population. The COVID-19 pandemic was associated with a decline in stone surgeries, particularly SWL. By 2021, PCNL and URS case numbers increased significantly with a smaller increase in SWL.
摘要：
2020年初，随着SARS-Cov-2（COVID-19）大流行的进展，许多机构限制非紧急手术。这与经皮肾镜取石术（PCNL）和输尿管镜检查（URS）长达十年的增加以及用于尿石症手术治疗的冲击波碎石术（SWL）的减少相吻合。在这里，我们评估了Medicare人群中的颞部结石手术率和外科医生数量，并建议COVID-19对其做出了贡献。使用“Medicare医师和其他从业人员”数据库进行回顾性分析，该数据库包含2013年1月至2021年12月的数据。包括接受结石手术的成年患者。我们评估了外科医生的特征和病例体积随时间的变化。2013年，泌尿科医师进行了68,910例结石手术：SWL42,903（62％）；URS25,321（37％）；PCNL686（1％）。在接下来的八年中，URS（13％）和PCNL（13％）的年均增长，SWL（-2％）的年均下降。2020年，所有病例均减少了16％：SWL（-26％）；URS（-8％）；PCNL（-1％，对于≥2cm的结石，-<2cm的58%）。到2021年案件数量增加，尽管SWL仍然很低：SWL33,974例（34%；COVID后+5%）；URS64,541例（64%；+16%）；PCNL1,764例（2%；+26%）。Cochrane-Armitage检验显著(p<0.001)。从2013年到2021年，执行SWL的泌尿科医师数量减少（1,718至1,361），而URS和PCNL增加了一倍（分别为1,347至2,914和28至76）。在2013年进行结石手术的NPI特定泌尿科医师中，35-50%在2019年六年后没有出现在数据集中；在2019年的泌尿科医师中，在COVID-19两年后，到2021年，30-42%没有出现在数据集中。从2013年到2021年，美国医疗保险人口的URS和PCNL有所增加，SWL下降。COVID-19大流行与结石手术的减少有关，特别是SWL。到2021年，PCNL和URS病例数大幅增加，SWL增幅较小。
