Objective
To examine the relative costs of prone percutaneous nephrostolithotomy (PCNL) versus
PCNL performed with the patient in the Galdakao-modified supine Valdivia (GMSV) position
to determine whether a cost differential exists.
Methods
We compared prone PCNL with PCNL using GMSV positioning. Cost data were obtained from
the urology departmental and hospital billing offices at our institution and from
the 2011 local Medicare reimbursement scales. The costs were divided into 5 major
categories: surgeon fees, anesthesia fees, surgical supplies, hospital-related fees,
and lost revenue.
Results
The overall cost of prone PCNL ranged from $23 423 to $24 463, and the cost for PCNL
performed with GMSV positioning ranged from $24 725 to $25 830. The difference between
the 2 positions ranged from approximately $1302 for stones ≤2 cm to $1367 for stones
>2 cm. The lost office revenue because of the requirement for a second surgeon was
estimated at $1987.
Conclusion
Our assessment of the cost for prone versus GMSV PCNL technique found GMSV positioning
to be more costly. The presence of 2 surgeons was the main driver of the cost differential,
because it resulted in more equipment use, with greater instrument repair costs and
higher surgeon fees. It also brings into consideration the opportunity cost of having
a second surgeon in the operating room and not in the office.
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Article info
Publication history
Published online: August 23, 2012
Accepted:
June 23,
2012
Received:
February 27,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
