Presentation Authors: Muhannad Alsyouf*, Dan Hur, Phillip Stokes, Sue Min Sophia Kown, Akin Amasyali, Mohammad Hajiha, Milan Shah, D Duane Baldwin, Loma Linda, CA
Introduction: Cost containment during ureteroscopy has been advocated recently, in the setting of reduced reimbursement rates. Academic centers must balance patient outcomes, operative efficiency and resident training, with little evidence regarding the effect of these factors upon cost. The purpose of this study was to evaluate intraoperative factors during ureteroscopy that can potentially impact direct hospital cost.
Methods: A retrospective review of 109 consecutive patients undergoing elective ureteroscopy at a single tertiary care academic medical center was performed. Average direct cost was defined as cost incurred by the hospital related to operating room expenses including operating room time, staffing, equipment, and supplies. Data regarding patient demographics, surgical indication, equipment used during procedure and staffing of procedure were recorded and compared between the most expensive and least expensive cases. Logistic regression analysis was performed to identify factors predictive of higher direct costs, with p < 0.05 considered significant.
Results: The median direct cost of ureteroscopy was $2963.0 ($ 1197.0-20,182.5). 76.1 % of cases made money and the average amount of money per case was $3,784.6. Ureteroscopy cases in the highest 50th cost percentile had larger mean stone size (170.1 vs. 146 mm2; p=0.039), longer operative times (95.3 vs. 49.9 mins; p < 0.01), were more likely to have a resident present (64.3 vs 43.6%; p=0.02), and to be performed for non-stone indications (21.4 vs 7.3%; p=0.034) when compared to the lowest 50th percentile. There was no differences in use of access sheath, type of ureteroscope used (flexible or semirigid), method of stone treatment (dusting or basketing), or whether an endourologist vs. general urologist performed the surgery (p>0.05 for all). On logistic regression analysis, average operating room time was the only significant predictor of higher average direct cost during ureteroscopy cases (B 29.9, 95%CI 17.2-42.5;p < 0.01).
Conclusions: This study highlights the primary importance of operative time upon costs during ureteroscopy. All efforts should be made to decrease operative time in order to decrease cost in these cases.