Surgical Stone Trends from 2013 to 2021 in the US Medicare Population: Before and After the COVID-19 Pandemic.

In early 2020 as the SARS-Cov-2 (COVID-19) pandemic progressed, many institutions limited non-urgent surgery. This coincided with a decade-long increase in percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) and decrease in shock wave lithotripsy (SWL) for surgical management of urolithiasis. Herein, we evaluate temporal stone surgery rates and surgeon volumes in the Medicare population and suggest how COVID-19 contributed to them. Retrospective analysis was conducted using the "Medicare Physician & Other Practitioners" database containing data from January 2013-December 2021. Adult patients who underwent stone surgery were included. We evaluated surgeon characteristics and changes in case volumes over time. In 2013 urologists performed 68,910 stone surgeries: SWL 42,903 (62%); URS 25,321 (37%); PCNL 686 (1%). Over the next eight years there was an average annual increase in URS (+13%) and PCNL (+13%) and decrease in SWL (-2%). In 2020 there was a 16% reduction in all cases: SWL (-26%); URS (-8%); PCNL (-1% for stones ≥2cm, -58% for <2cm). By 2021 case volumes increased, though SWL remained low: SWL 33,974 (34% cases; +5% after COVID); URS 64,541 (64% cases; +16%); PCNL 1,764 (2% cases; +26%). Significant on Cochrane-Armitage test (p<0.001). From 2013 to 2021, the number of urologists performing SWL decreased (1,718 to 1,361) while URS and PCNL doubled (1,347 to 2,914 and 28 to 76, respectively). Of NPI-specific urologists performing stone surgeries in 2013, 35-50% were not in the dataset six years later in 2019; of urologists in 2019, 30-42% were not in the dataset by 2021, after two years of COVID-19. From 2013-2021 there was an increase in URS and PCNL and decrease in SWL in the US Medicare population. The COVID-19 pandemic was associated with a decline in stone surgeries, particularly SWL. By 2021 PCNL and URS case numbers increased significantly with a smaller increase in SWL.