Increasing Percutaneous Nephrostomy Procedures in the United States: Contemporary Trends from the National Inpatient Sample 2005-2019

Purpose: To assess annual changes in utilization of nephrostomy interventions over time to better understand the evolving role of interventional radiology (IR) in the management of urinary conditions, such as obstruction and leakage, and in providing access for further urological procedures.

Methods/Materials: The National Inpatient Sample (NIS), an all-payer, discharge-level, administrative database, was queried for years between 2005 to 2019 using ICD-9 and ICD-10 codes consistent with placement and exchange of nephrostomy tubes. Relevant data including patient demographics, hospital setting, and hospital geographic region as defined by the US Census were reviewed. National estimates were made using discharge weights provided in the database. Compound annual growth rate was used to quantify change over time. Linear regression was used to identify significant trends.

Results: A total of 525,719 nephrostomy tube placements and 213,421 exchanges occurred during the study period. Annual volume of nephrostomy tube placement increased by 91.8%, from 27074 to 51915 (CAGR = 4.76%). Annual volume of exchange increased by 214.0%, from 8057 to 25295 (CAGR = 8.51%). Significant linear trends were observed in both nephrostomy tube placement and exchange (P < 0.001, P < 0.001). These trends persisted when analyzed across all geographic regions including Northeast, Midwest, South, and West (P < 0.001 for all regions). The greatest rate of increase was seen in the West region (CAGR = 7.08% for placement, CAGR = 9.65% for exchange). Most placements and exchanges occurred in urban teaching hospitals (84.4% of placements and 87.1% of exch anges in 2019)

Conclusions: An increase in percutaneous nephrostomy procedures in the inpatient setting has occurred. A higher rate of increase in nephrostomy tube exchange when compared to placement suggests an increasing population of patients with indwelling nephrostomy tubes. These trends illustrate an increasing healthcare burden and highlights the footprint of IR services in the treatment of urologic conditions.