Retrograde stent with external string for pediatric robotic pyeloplasty: does it reduce cost and complications?

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Health Economics

Background:

• Ureteropelvic junction obstruction (UPJO) is commonly treated in children using robotic-assisted pyeloplasty (RAP).
• Traditionally, ureteral stent removal requires a separate operating room visit and anesthesia.
• Our institution implemented a stent with external string (SWES) approach prior to RAP to streamline care.

Purpose of the Study:

• To quantify the operative time, complications, and costs associated with the SWES approach compared to traditional methods.
• To evaluate the impact of SWES on healthcare costs and unplanned hospital returns.
• To assess national trends in postoperative drainage management following pediatric RAP.

Main Methods:

• Retrospective collection of pediatric RAP cases utilizing the SWES approach (Aug 2012-July 2017).
• Comparison of 30-day healthcare costs using the Pediatric Health Information System (PHIS) database against a national cohort.
• Anonymous electronic survey to PHIS institutions regarding predominant postoperative drainage techniques.

Main Results:

• The SWES cohort demonstrated significantly lower median 30-day healthcare costs ($10,548) compared to the national RAP cohort ($14,119, p < 0.001).
• The SWES group experienced a 15.5% rate of unplanned hospital returns, with 8.2% requiring a procedure.
• Nationwide survey revealed 84.6% of institutions primarily leave stents without strings post-RAP.

Conclusions:

• The SWES approach for pediatric RAP is associated with substantial cost savings (approx. 25%) and avoids a second anesthetic for stent removal.
• While SWES reduces overall costs, it is linked to an increased risk of unplanned returns for procedures.
• Current national practice predominantly favors leaving ureteral stents without strings after pediatric RAP.