Cost Value Analysis of Single Incision Midurethral Sling Insertion in the In Office Vs. Hospital Setting

Abstract

<h3>Study Objective</h3> Patient outcomes between Mid-urethral slings in office setting vs hospital setting based on average total patient encounter time, total procedure time, total patient cost. The secondary outcomes were adverse events, unexpected outcomes, and urgent evaluation. <h3>Design</h3> Retrospective, double-arm study, 1 physician implanted a mid-urethral single-incision sling with the clinical diagnosis for urethral hypermobility or stress urinary incontinence. <h3>Setting</h3> Office setting and hospital-based setting. <h3>Patients or Participants</h3> 78 women underwent sling placement in an office setting and 47 patients underwent sling placement in a hospital-based setting. <h3>Interventions</h3> Patients were evaluated at 2 and 6 weeks after surgery. A validated Surgical Satisfaction Questionnaire (SSQ-8) was collected at the 6-week post-operative visit. Patients that did not complete the SSQ-8 were contacted by phone. All women with the diagnosis of urethral hypermobility or stress urinary incontinence. <h3>Measurements and Main Results</h3> Between January 2016 until August 2020 a total of 125 women underwent a single incision mid urethral sling procedure. Hospital-based setting: The average SSQ-8 score totaled 39.17 out of 40. The average total patient encounter time was 344.702 minutes. The average total time in the OR was 50.06 minutes. 5 total patients reported one adverse event, 13 patients reported 6 unexpected outcomes. No patients were seen for emergent evaluation. Office-based setting: The average SSQ-8 score totaled 39.48 out of 40. The average total patient encounter time was 53.76 minutes. The average total time in the OR was 22.05 minutes. 5 total patients reported one adverse event, 25 patients reported 27 unexpected outcomes. 1 patient was seen for emergent evaluation. No statistically significant differences in patient satisfaction. <h3>Conclusion</h3> The findings have shown considerable favor office-based setting in comparison to the hospital setting. There is a significant difference in the financial cost and the total patient encounter time. The office-based setting would be the more advantageous option for patients. The office-based setting is cost-effective, less time-consuming, and is safe.