Estimates of the number of cancer patients hospitalized in a geographic area using claims data without a unique personal identifier.

OBJECTIVE: In French national claims databases, claims are currently anonymous i.e. not linked to individual patients. In order to improve our estimate of the medical activity related to cancer in one French region, a statistical method was developed to use claims data to assess the number of cancer patients hospitalized in acute care. METHODS: This method used the medical and administrative information available in the claims (i.e. age, primary site, length of stay) to predict an average number of stays per patient, followed by a number of patients. It was based on a two-phase study design using an internal dataset which contained personal identifiers to estimate the model parameters. RESULTS: The predicted number of acute care patients hospitalized in one or several health care centers in one French region was 38,109 with a 95% predictive interval (37,990; 38,228) for the first six months of 2002. A prediction error of 24 per thousand was found. CONCLUSION: We provide a good estimate of the morbidity in acute care hospitals using claims data that is not linked to individual patients. This estimate reflects the medical activity and can be used to anticipate acute care needs.

[Treatment of renal and ureteral lithiasis]. / Traitement de la lithiase rénale et urétérale.

The advent of extracorporal shock wave lithotripsy has entirely changed management of patients with renal or ureter calculi. It is indicated in all types of calculi and generally used as first line treatment. Contraindications are exceptional: pregnancy, uncorrectable coagulation disorders. For staghorn calculi in the kidney, lithotripsy alone is only effective in 50% of the cases and is often completed or preceded by percutaneous nephrolithotomy. Classical surgical procedures may be required in complex cases. Success rate (complete stone free with none residual) with lithotripsy is higher for pelvic stones (70%) and small residual fragments are usually asymptomatic and rarely infected. There is still some debate over indications for ureteral calculi although use of in situ lithotripsy with an ureteral probe. The ureteroscopy is more effective for stones in the distal ureter. In all cases, the final factor in the management decisions is cost-effectiveness.

Systematic removal of catheter 48 hours following transurethral resection and 24 hours following transurethral incision of prostate: a prospective randomized analysis of 213 patients.

The interval before removal of the catheter used in prostatic transurethral surgery depends to a great extent on the surgeon, with a frequently empirical orientation. We conducted a prospective, randomized and controlled study of 213 patients who underwent transurethral surgery for benign prostatic hyperplasia. The catheter was removed systematically 24 hours after transurethral incision and 48 hours after transurethral resection of the prostate (group 1-52 and 54 patients, respectively) or the catheterization interval was determined by each surgeon in accordance with the usual criteria (group 2-52 and 55 patients, respectively). No statistically significant differences were noted between these 2 groups in regard to complications. We conclude that systematic removal of the catheter at the aforementioned periods is cost-effective, safe and comfortable for the patient.

[Percutaneous nephrolithotomy after failure of extracorporeal shockwave lithotripsy. Indications, results, perspectives]. / Néphrolithotomie per-cutanée après échec de lithotritie extra-corporelle par ondes de choc. Indications, résultats, perspectives.

Eighty-one of the 579 extracorporeal lithotripsies (ECL) performed between 1987 and 1992 with an ultrasound-guided hydroelectric lithotriptor required the use of another treatment modality. 53 percutaneous nephrolithotomies (PCNL) were performed in these 81 patients after failure of ECL (21 for non-fragmentation, 32 for residual fragments). The authors analyse the factors responsible for failure in order to select the more appropriate type of treatment for different types of stones. The site of the stones, their size, their radiographic appearance, their chemical composition, the number of ECL sessions and the number of days spent in hospital were compared between the PCNL and ECL groups. Smooth, homogeneous stones denser than bone and larger than 15 mm in diameter were significantly more resistant to ECL, despite an increased number of shock waves. PCNL was successful in 92% of cases of non-fragmented stones (with no residual fragments). The success rate for multiple residual fragments was 64%. In view of the risk of complications associated with residual fragments, regardless of their size, the potential risks of ECL and cost imperatives, the authors recommend that these stones, considered to be resistant, should be treated immediately by PCNL, as the results of PCNL after ECL are less satisfactory.