In 2017, I was honored to receive an AUA Data Grant to study the costs and procedural trends of ambulatory urological surgery in the US. The funding from this grant allowed us to acquire the AHRQ (Agency for Healthcare Research and Quality) State Ambulatory Surgery and Services Database files. These files contain all payer encounter–level data for ambulatory surgeries in several states, which are ideal for answering questions about health services utilization and cost. With these files, we were able to analyze the relative change in volume, cost, and site of service over time. This is of particular importance within the field of urology given the ambulatory nature of our practice.

The full details of our findings are summarized in the 2019 Urology Practice^® article, “Trends in the Setting and Cost of Ambulatory Urological Surgery: An Analysis of 5 States in the Healthcare Cost and Utilization Project.”¹ However, in brief, we found that approximately 5% of all ambulatory surgeries performed over 5 years in 5 states were urological, which increased year over year, and cost similarly increased, although it was lower in a free-standing ambulatory surgery center and for surgeons who were in the top quartile of procedure volume.¹ These findings provide quantifiable evidence that our procedures are continuing to transition to the outpatient setting, although not necessarily at an overall cost savings. This information can be very useful to policy makers, but also for advocates such as the AUA who lobby on behalf of our profession for appropriate and fair regulation and reimbursement.

Although the original AUA Data Grant was focused exclusively on assessing broad trends in ambulatory urological surgery, the nature of the data allowed for additional questions to be answered. As an endourologist with a specific interest in nephrolithiasis, I was able to examine a very important yet practical question relevant to both surgeons and patients. We quantified the unplanned revisit rate after upper urinary tract procedures for kidney stone removal relative to the lower urinary tract procedure of cystoscopy. The full details of our findings are summarized in the 2021 Urolithiasis article, “Emergency Department and Hospital Revisits After Ambulatory Surgery for Kidney Stones: An Analysis of the Healthcare Cost and Utilization Project.”² However, in brief, we found that the majority of these unplanned visits occurred within 2 weeks for pain or infection at the approximate rates of 6%, 7%, and 9% for shockwave, ureteroscopy, and nephrolithotomy, respectively.² These results provide a discrete number useful for patient counseling and can serve as a benchmark for quality metrics.

These 2 publications represent the culmination of a significant amount of personal labor but also are a testament to the help and assistance of my partners. In this case, I was fortunate to receive guidance and feedback from Dr Matlaga, one our field’s most successful health services researchers. In turn, I was able to mentor 2 very talented trainees, 1 senior urology resident, Dr Hiten Patel, and 1 senior medical student, now Dr Katharine Michel. As their mentor, I was able to bring them in on the earliest phases of the research and guide them through the process. In return, I learned from them as they brought their complementary expertise in biostatistics and health policy. In the end, we all benefited from the AUA Data Grant as it made this type of mentorship arrangement possible.

Although ultimately successful, the research process was not always easy. At the time of the grant application, I was in the last year of my endourology fellowship, and at receipt of the award, in my first year on faculty. This was a critical transition period where I went from a trainee being guided and mentored by accomplished senior scientists to an independent faculty researcher with the expectation of having a research portfolio of ideas and projects. The AUA Data Grant helped to provide support and purpose during this early phase of my career, which felt challenging and uncertain at times.

The AUA Data Grant process helped both Dr Patel and I learn several important lessons early, which has subsequently facilitated our current career goals and trajectory. First, the grant writing process is challenging, time consuming, and sometimes painful, but equally satisfying as it generates creativity, innovation, and collaboration. Second, despite the best efforts to develop a novel and important research question with elegant and practical aims, it is vital to remain flexible, as implementing a research plan in the real world requires humility, compromise, and support. Third, prepare for the generation of new ideas and academic relationships as the project progresses, both of which will help guide future research endeavors and focus.

With these lessons in hand and the successful completion of the AUA Data Grant, I was able to continue my academic journey by meaningfully contributing to several subsequent projects and trials funded by both the NIH and the Patient-Centered Outcomes Research Institute. I would encourage anyone who is interested in building a research career in urological disease, particularly trainees and junior faculty, to seek out and apply for one of the many funding opportunities offered by the AUA. These grants and the support of the AUA will set you up for academic success.