Abstract
PurposeTo perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures.MethodsWe analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs.ResultsOperative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p < 0.001), but total procedural costs were equivalent (p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p < 0.001). Multivariable linear regression analysis revealed that LOS and OT were associated with hospitalization costs (all p < 0.001), after accounting for vmPCNL procedure, patients’ comorbidities, and complications.ConclusionvmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs.
Highlights
Percutaneous nephrolithotomy (PCNL) is recommended as the standard procedure for large renal stones [1]
Hospital stay was longer after minimally invasive PCNL (MIP) than vacuum-assisted mini PCNL (vmPCNL) procedures (p = 0.03) and the SF rate was higher after vmPCNL than MIP (p = 0.04)
Despite the additional cost of the disposable nephrostomic sheath, total procedural costs were comparable between groups, but total hospitalization costs were lower for vmPCNL than MIP
Summary
Percutaneous nephrolithotomy (PCNL) is recommended as the standard procedure for large renal stones [1]. Miniaturized PCNL was found to be as effective as standard procedure, but with decreased morbidity rates, bleeding, postoperative pain and shorter hospitalization [3, 4]. Major drawbacks of miniPCNL are longer operative time (OT), decreased visibility and higher intra-pelvic pressure, which is associated with postoperative infectious complications [5, 6]. The vacuum-assisted mini PCNL (vmPCNL) is a safe and effective treatment option for kidney stones [12, 13]. Previous Authors have shown that vmPCNL was associated with shorter OT, reduced use of accessory devices for stone removal and lower intra-pelvic pressures than mini-PCNL, thanks to its continuous aspiration system that allows for simultaneous lithotripsy and litholapaxy [13, 14]. One of the major drawbacks of this system is its disposability, which may limit its use in the everyday clinical practice due to the fear of increasing the procedure-related costs
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