Login to Access Video or Poster Abstract: MP75-18
Sources of Funding: none

Introduction

Establishing access into a kidney is a prerequisite for percutaneous nephrolithotomy (PCNL). Currently, access is urologist-obtained (UOA) or radiologist-obtained. Ancillary services like interventional radiology (IR) add significant cost and delay, impacting hospital profit margin.

Methods

We performed a retrospective review of our institutional database of consecutive PCNLs from 01/2014 to 09/2015. The study subjects were separated by which group established renal access. Patient characteristics and clinical variables including blood loss, change in laboratory parameters, length of stay, and complications were analyzed. Costs and material expenses were also compared. Statistical analysis was performed using chi-square, Fisher&[prime]s exact test, and t-test. P value < 0.05 was considered significant.

Results

Of the 76 PCNLs, 23 (30%) cases contained a UOA. These were performed by two fellowship-trained endourologists: one who routinely obtains renal access and the other who routinely has initial access by IR. The operative details, post-operative parameters, and length of stay were not significant (Table 1). No significant differences in overall complications existed between the two groups (p=0.82). The materials cost for the operating room was higher for a UOA, but not significant (Table 2). When factoring ancillary service costs, the difference became significant ($1500.13 vs. $2150.90, p = 0.0001). Average total cost was cheaper for a UOA PCNL, $29,997.12 versus $34,299.39, or a savings of $4,302.27. Analysis using specific operating room and IR staff/facilities costs show that there is about a 20-minute buffer before the cost-benefit of establishing a UOA is erased.

Conclusions

Either method of access is suitable for PCNL and offers no significant advantage to clinical outcomes. However, the use of IR led to a 14% increase in costs.

Funding

none