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A cost comparison of nephron‐sparing surgical techniques for renal tumour
Author(s) -
Lotan Yair,
Cadeddu Jeffrey A.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05461.x
Subject(s) - medicine , nephrectomy , radiofrequency ablation , percutaneous , ablation , surgery , urology , radiology , kidney
The cost of nephron‐sparing renal tumour surgical techniques was compared by authors from Dallas, assessing open partial nephrectomy, laparoscopic partial nephrectomy and percutaneous radiofrequency ablation. They found that radiofrequency ablation was significantly less costly, with the other two techniques being cost‐equivalent. Authors from Philadelphia devised a study to determine the optimum size of flexible ureteroscope to minimize the need for ureteric dilatation. They found that the ability to pass the ureteroscope was directly related to their outer diameter, with the ideal being 7.4 F. OBJECTIVE To compare costs associated with open partial nephrectomy (OPN), laparoscopic PN (LPN) and percutaneous radiofrequency ablation (PRF) in consecutive patients undergoing nephron‐sparing surgery. PATIENTS AND METHODS The charts and costs were reviewed for all 46 patients undergoing nephron‐sparing PN at our institution from March 2003 to March 2004. Clinical characteristics, operative techniques, radiographic and pathological information were recorded. Detailed cost information for room and board, laboratory, pharmacy, radiology, operating room, surgical supplies, anaesthesia, recovery room, electrocardiography and respiratory services were obtained from our institution. RESULTS The hospital stay was significantly shorter for PRF (0.5 days) than either LPN (1.86) and OPN (4.94). PRF was statistically less costly than LPN and OPN, with mean ( sd ) costs of (US$) 4454 (938), 7013 (934) and 7767 (1605). There was no significant difference in cost between LPN and OPN. Surgical supply costs were significantly higher for LPN and PRF than OPN. LPN had less than a third of the room and board costs of OPN ( P < 0.001). Decreases in room and board were also associated with lower pharmacy and laboratory costs. CONCLUSIONS PRF is significantly less costly than LPN and OPN; LPN is cost‐equivalent to OPN as the shorter stay compensates for significantly higher surgical supply costs. In those patients with tumours of appropriate size and location, minimally invasive approaches can decrease the morbidity, with cost benefits.