Open AccessCosts variations for percutaneous nephrolithotomy in the U.S. from 2003–2015: A contemporary analysis of an all-payer discharge database
Author(s) -
Jeffrey J. Leow,
Anne-Sophie Valiquette,
Benjamin I. Chung,
Steven L. Chang,
QuocDien Trinh,
Rus Korets,
Naeem Bhojani
Publication year - 2018
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.5280
Subject(s) - medicine , percutaneous nephrolithotomy , confidence interval , odds ratio , percentile , charlson comorbidity index , healthcare cost and utilization project , population , quartile , health care , emergency medicine , demography , database , comorbidity , surgery , percutaneous , statistics , environmental health , mathematics , computer science , economics , economic growth , sociology
We sought to evaluate population-based cost variations and predictors of outlier costs for percutaneous nephrolithotomy (PCNL) in the U.S.
Methods: Using the Premier Healthcare Database, we identified all patients diagnosed with kidney/ureter calculus who underwent PCNL from 2003–2015. We evaluated 90-day direct hospital costs, defining high- and low-cost surgery as those >90th and <10th percentile, respectively. We constructed a multilevel, hierarchical regression model and calculated the pseudo-R2 of each variable, which translates to the percentage variability contributed by that variable on 90-day direct hospital costs.
Results: A total of 114 581 patients underwent PCNL during the 12-year study period. Mean cost in the low-cost group was $5787 (95% confidence interval [CI] 5716–5856) vs. $38 590 (95% CI 37 357–39 923) in the high-cost group. Cost variations were substantially impacted by patient (63.7%) and surgical (18.5%) characteristics and less so by hospital characteristics (3.9%). Significant predictors of high costs included more comorbidities (≥2 vs. 0: odds ratio [OR] 1.81; p=0.01) and hospital region (Northeast vs. Midwest: OR 2.04; p=0.03). Predictors of low cost were hospital bed size of 300–499 beds (OR 1.35; p<0.01) and urban hospitals (OR 2.77; p=0.01). Factors less likely to be associated with lowcost PCNL were more comorbidities (Charlson Comorbidity Index [CCI] ≥2: OR 0.69; p<0.0001), larger hospitals (OR 0.61; p=0.01), and teaching hospitals (OR 0.33; p<0.0001).
Conclusions: Our contemporary analysis demonstrates that patient and surgical characteristics had a significant effect on costs associated with PCNL. Poor comorbidity status contributed to high costs, highlighting the importance of patient selection.