MP28-06 COST ANALYSIS OF FLEXIBILE URETEROSOPE REPAIRS: EVALUATION OF 655 PROCEDURES IN A COMMUNITY-BASED PRACTICE EXPERIENCE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2015MP28-06 COST ANALYSIS OF FLEXIBILE URETEROSOPE REPAIRS: EVALUATION OF 655 PROCEDURES IN A COMMUNITY-BASED PRACTICE EXPERIENCE Eugene Kramolowsky, Zachary McDowell, Blake Moore, David Rapp, and Nada Wood Eugene KramolowskyEugene Kramolowsky More articles by this author , Zachary McDowellZachary McDowell More articles by this author , Blake MooreBlake Moore More articles by this author , David RappDavid Rapp More articles by this author , and Nada WoodNada Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The frequency of flexible ureteroscopy has increased with the introduction of improved instrumentation. These ureteroscopes allow increased endoscopic access to the ureter and kidney. However, the repairs required to maintain the scopes may increase the total expense related to the procedure. METHODS Over a three year period (8/2011 - 7/2014), 655 flexible ureteroscopies were performed at a single specialty urology ambulatory surgery center. The procedures were performed by 26 board certified urologists (15 doing greater than 10 cases) using four Olympus URF P5 flexible ureteroscopes. The instruments were handled by a single team and sterilized via the Steris System E1. Repairs were performed by the manufacturer on an as needed basis. Patient records were reviewed to determine the pre-op diagnosis, operative (OR) time, location and size of the stone, use of laser and use of ureteral sheath. The occurrence, nature of flexible ureteroscope damage, and cost of repairs were evaluated. RESULTS Of the 655 flexible ureteroscopies performed, 81% were for the treatment of calculi with 47% of these in the kidney. The mean stone size was 8.3 mm, with the larger stones (11 mm) located in the kidney. In the majority of cases (88%), the flexible ureteroscope was advanced over a guidewire. A laser fiber was introduced in 86% of the cases. A ureteral sheath was used in 12% of the cases. The mean procedure time was 39 minutes. The most common reasons for ureteroscope repair were cloudy lens (16) and broken optic fibers (9). There were 31 repairs during the study period (average 21 cases per repair). The flexible ureteroscopes were out of service for an average of 11 days per repair (range 3 - 20). The total cost of repairs was $233,150 or approximately $7,521 per repair. The average repair cost per flexible ureteroscopy performed was $355. CONCLUSIONS In an era of OR cost containment, the expenses associated with the repair of instruments can significantly impact the reimbursement of a procedure, thus efforts should be made to minimize instrument breakage. The expense of repairing a flexible ureteroscope per procedure can be significant and needs to be considered when pricing this procedure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e313 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Kramolowsky More articles by this author Zachary McDowell More articles by this author Blake Moore More articles by this author David Rapp More articles by this author Nada Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...