Increasing follow-up and decreasing morbidity in nephrostomy tube exchange in cancer patients

Purpose: Interventional radiologists are frequently consulted to perform percutaneous nephrostomy (PCN) tube drainage for upper urinary tract obstruction from malignancies. However, these patients often visit the emergency room (ER) for PCN complications, including pain, dislodgment, recurrent obstruction, and infection. The goal of this study was to assess variables that impact PCN-related ER visits and urgent PCN exchanges.

Methods/Materials: We performed a retrospective review of patients presenting to safety net hospital system with with upper tract obstruction due to malignancy who had undergone acute PCN placement from the emergency department. A total of 131 patients met inclusion criteria. Multivariate analyses of variance (MANOVA) were performed to determine whether age, diabetes mellitus, body mass index, laterality of PCN placement, cancer type, Eastern Cooperative Oncology Group (ECOG) score, systemic therapy within 30 days of PCN placement, hospice status, or treatment hospital was associated with the number of ER visits or the need for urgent PCN exchanges in this patient population.

Results: ECOG score (p=0.048) and the treatment hospital (p=0.025) were significantly associated with the average number of ER visits. The treatment hospital was also significantly associated with the average number of urgent PCN exchanges (p=0.037). We then compared the average time in between PCN exchanges at each of the hospitals in our study. This revealed that hospital A had a higher average length of time between PCN exchanges compared to hospital B (82 vs 51 days, p< 0.0001).

Conclusions: Overall, these data show that the more often PCN were exchanged, the less likely patients were to present to the ER. It is possible that the difference in how often patients receive scheduled exchanges impacts how often they have to visit the ER or undergo urgent procedures. Therefore, more frequently scheduled PCN exchanges could improve the quality of life and decrease morbidity in this vulnerable patient population. These results will inform practice patterns for scheduled PCN exchanges to maximize quality improvement.