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Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis
Author(s) -
Schimpf MO,
Gottenger EE,
Wagner JR
Publication year - 2008
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2008.01757.x
Subject(s) - medicine , hysterectomy , current procedural terminology , surgery , ureter , perioperative , reimbursement , abdominal hysterectomy , urinary catheterization , population , general surgery , health care , catheter , economics , economic growth , environmental health
Objective Iatrogenic ureteral injury during gynaecological surgery is associated with increased morbidity when not diagnosed during the initial surgery. Preoperative insertion of ureteral catheters may enhance intraoperative recognition of injury and repair, but it is controversial. We sought to analyse the costs of this approach. Design/setting/population A decision‐tree analysis of clinical scenarios of using universal ureteral catheterisation compared with no catheterisation was conducted for benign abdominal hysterectomy and radical hysterectomy. Methods Diagnostic‐Related Groups and Current Procedural Terminology coding and reimbursement information were used as calculated for Medicare patients in the USA. Main outcome measures Differences in projections of total hospital‐related costs related to clinical scenarios of perioperative care for women undergoing hysterectomy with or without ureteral catheterisation. Results Universal ureteral catheterisation is cost saving when the rate of ureteral injury during benign abdominal hysterectomy or radical hysterectomy is greater than 3.2%. Conclusions The cost savings of universal ureteral catheterisation at hysterectomy depend on the injury rate but are minimal at common levels of injury.