Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath

Area of Science:

• Urology
• Health Economics
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Vacuum-assisted PCNL (vmPCNL) and minimally invasive PCNL (MIP) are variations with distinct cost profiles.
• Understanding the economic implications of each technique is crucial for healthcare providers.

Purpose of the Study:

• To conduct a comparative cost analysis of vmPCNL and MIP.
• To identify predictors of procedural and hospitalization costs in PCNL.
• To evaluate the clinical and economic benefits of vmPCNL.

Main Methods:

• Analysis of data from 225 patients undergoing vmPCNL or MIP between 2016-2020.
• Propensity score matching to create comparable cohorts (108 vmPCNL, 54 MIP).
• Statistical analysis including descriptive statistics, univariable, and multivariable linear regression to assess cost predictors.

Main Results:

• vmPCNL had shorter operative times (OT) and higher stone-free rates compared to MIP.
• MIP had longer length of stay (LOS) and higher overall hospitalization costs.
• While vmPCNL had higher instrumentation costs, total procedural costs were equivalent, and hospitalization costs were lower.

Conclusions:

• vmPCNL presents a clinically and economically viable alternative to MIP.
• Reduced OT, lower disposable equipment use, and fewer complications contribute to vmPCNL's cost-effectiveness.
• vmPCNL demonstrates potential for reduced procedural and hospitalization expenses in kidney stone management.