Presented by: Ezra Margolin MD
Duke University Medical Center

Introduction

Ureteral stones commonly affect patients of working ages and disrupt daily activities. Patient reported outcomes during a trial of passage have been understudied which leads to difficulty in setting patient expectations. We sought to characterize work productivity losses among individuals passing a ureteral stone.

Materials

We identified employed, English speaking patients between the ages of 18-64 and discharged from Duke University Health System emergency departments with unilateral ureteral stones from February 7, 2022 to February 7, 2023. Patients were contacted by phone 4 weeks after discharge and administered the Institute for Medical Technology Assessment Productivity Cost Questionnaire which evaluates three domains of productivity loss over a four week period: absenteeism (missed work), presenteeism (decreased productivity at work), and volunteerism (help with unpaid work or domestic tasks). Patients were determined to have passed their stone if they noticed it in the toilet or identified a day where symptoms resolved and did not return.

Results

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112 patients completed the survey. 62% (69/112) of participants reported passing their stone, with a median of 3 days until passage (interquartile range [IQR] 1—7 days). 13% (14/112) of participants had surgery before survey completion. In total, 68% (76/112) of participants reported missing work (Figure 1), with a median absence of 2 days (IQR 1—5 days). Participants who passed their stone missed a median of 50% (IQR 21%—100%) of working days until their stone passed. 46% (52/112) of participants endorsed decreased productivity when they returned to work, reporting their effectiveness at a median of 70% (IQR 50%—80%). 55% (62/112) of participants reported requiring unpaid work, or help with tasks around the house.

Conclusion

Missed work and decreased productivity when returning to work is common among patients undergoing a trial of passage for ureteral stones. However, many patients only miss a couple days of work. While direct comparative data for ureteroscopy is lacking, this suggests that immediate surgical treatment during an acute stone episode may not significantly decrease work absence over a trial of passage. This information will be important to appropriately counsel patients in EDs on options for management during an acute stone episode.

Funding

None

Co-Authors

Robert Medairos, MD
Duke University Medical Center

Alexandria Spellman, MD
Duke University Medical Center

Vishnukamal Golla, MD, MPH
Durham Veterans Affairs Medical Center

Michael Lipkin, MD, MBA
Duke University Medical Center

Gary Faerber, MD
Duke University Medical Center

Jodi Antonelli, MD
Duke University Medical Center

Charles Scales, MD, MSHS
Duke University Medical Center

Deborah Kaye, MD, MS
Duke University Medical Center