New Research Shows Efficacy for Postoperative Use of POCUS in Cases of Pyeloplasty

New research from the Division of Pediatric Urology at UPMC Children’s Hospital of Pittsburgh published in August in the Journal of Pediatric Urology showed a number of efficacious outcomes related to the use of point-of-care ultrasound (POCUS) in the postoperative period for cases of pyeloplasty.

The research was led by former Department fellow Jeffrey Villanueva, MD. Glenn M. Cannon, MD, chief of Pediatric Urology at UPMC Children's, was Dr. Villanueva's mentor on the research project.

This research aimed to determine if follow-up ultrasound imaging by urologists is efficient, cost-effective, and safe, and that quality and diagnostic determinants are equal to imaging procedures conducted in the radiology department.

Performing point-of-care ultrasound imaging for pyeloplasty patients in the clinic as opposed to complete retroperitoneal ultrasound (CRUS) in the radiology department can cut down on the amount of time patients need to spend in the hospital and clinic, but only if it is possible to maintain similar levels of quality and detection rates of the patient’s hydronephrosis status. 

The retrospective analysis examined a cohort of 45 patients who had a previous pyeloplasty procedure for a ureteropelvic junction obstruction (UPJO).

During patient-follow up, which for this cohort was a mean period of 29 months, there were 67 POCUS and 73 CRUS imaging procedures performed. Dr. Villanueva and colleagues research examined the incremental length of time needed during patient visits for CRUS, cost analysis on the additional charges to payers between CRUS and POCUS imaging, and the detection rates of instances of hydronephrosis – whether they were improving, stable, or becoming worse.

"In our study, we did not find any difference in rates relative to hydronephrosis detection. Our analysis showed that CRUS patients spend on average an additional two hours more in the hospital for their visit, and there was a related increase in charges to payers approaching $84,000. It would appear that with the appropriate training, POCUS imaging for pyeloplasty patients by the urologist can be done accurately and efficiently. That is not to say that POCUS can or should replace CRUS in every instance for every patient, but it does appear to be a viable option with benefits to patients, health care systems, and insurance payers," says Dr. Cannon. 

More About the POCUS Program at UPMC Children’s

UPMC Children’s Hospital of Pittsburgh has one of the most extensive point-of-care ultrasound (POCUS) programs in the United States. Begun in 2015, the hospital-wide POCUS program encompasses 14 subspecialties. The Division of Pediatric Urology is one of the 14 subspecialties taking part in the program and has an extensive patient data history on its use that is being used for ongoing research projects.

The hospital-wide POCUS program at UPMC Children's Hospital is only a handful in existence in the United States. The program is currently led by emergency medicine physician and Point-of-Care Ultrasound Medical Director Jennifer Marin, MD, MSc. The goal of the POCUS program is to improve patient care across a mix of diverse clinical specialties by standardizing the performance of point-of-care diagnostic and procedural ultrasound for many conditions and care scenarios.

Reference

Villanueva J, Pifer B, Colaco M, Fox J, Chaudhry R, Schneck FX, Cannon GM. Point-of-Care Ultrasound Is an Accurate, Time-Saving, and Cost-Effective Modality for Postoperative Imaging After Pyeloplasty. J Pediatr Urol. 2020 Aug; 16(4): 472.e1-472.eg.