Impact of a National Pediatric Kidney Stone Network on Postoperative Ultrasound Imaging Adherence: A Bi-Institutional Study

Adherence to follow-up care is critical for reducing the risk of kidney stone recurrence, especially in children, who may experience higher recurrence rates than adults. The Pediatric Kidney Stone (PKIDS) Care Improvement Network conducted a multi-institutional observational trial to evaluate the effectiveness of kidney stone surgeries. This study assessed the relationship between patient participation in this incentivized trial and adherence to obtaining postoperative ultrasound imaging from two institutions participating in PKIDS. We hypothesized that the provision of financial incentives and dedicated support staff would enhance adherence to postoperative follow-up imaging. Patients who underwent kidney stone surgery after the PKIDS trial commenced at the University of Alabama at Birmingham (UAB) and Nationwide Children’s Hospital (NCH) were included in this analysis. Participants in the PKIDS trial were required to obtain a postoperative ultrasound within 12 weeks of surgery and received remuneration for their participation. A dedicated research coordinator was assigned to monitor adherence and communicate with families. Adherence was defined as the acquisition of renal imaging within 120 days post-surgery. We compared demographics, stone presentation, and types of surgical interventions using Fisher’s exact test and the Mann–Whitney U test for categorical and continuous variables, respectively. The study included 240 patients, of whom 157 were enrolled in PKIDS and 83 were not. However, there was no significant difference in adherence to postoperative imaging between the PKIDS and non-PKIDS groups (79% vs. 71%, p=0.17). Moreover, there were no notable differences in demographics, stone presentation, or socioeconomic factors between the two groups (p>0.05). Our findings indicate that enrollment in PKIDS did not result in improved imaging adherence at the two participating sites. Despite the financial incentives and dedicated personnel, postoperative imaging rates remained low, suggesting a need for further studies to explore additional socioeconomic factors influencing adherence.