Fanning James, Fenton Bradford, Jean Geraldine Marie, Chae Clara
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Pennsylvania State University Milton S. Hershey Medical Center, 500 University Dr, Room C-3620, Hershey, PA 17033-2360, USA.
J Am Osteopath Assoc. 2011 Dec;111(12):667-9.
Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost.
To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.
All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed.
Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380.
Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as scientific data suggesting a lack of effectiveness, the authors argue that prophylactic intraoperative ureteral stenting should not be used in gynecologic surgery to decrease operative ureteric injury.
预防性术中输尿管支架置入术旨在减少术中输尿管损伤，不过关于该手术有效性的数据较少，且尚无其成本方面的数据。
分析妇科手术中预防性膀胱镜下输尿管支架置入术的成本。
通过Summa健康系统的电子病历数据库，识别并回顾性分析在1年期间妇科手术中所有预防性输尿管支架置入病例。成本通过医疗成本核算系统获取。采用成本效益分析原则（即对成本及成本效益统计数据进行明确且详细的描述）。重要的是，我们评估的是成本而非收费或财务模型估算值。此外，我们还获取了预防性输尿管支架置入术的边际贡献（即医院的净利润或亏损）。同时也对其他妇科手术进行了分析。
在792例主要的住院妇科手术中，识别出18例预防性术中输尿管支架置入病例。中位数成本如下：预防性术中输尿管支架置入的额外成本为1580美元；手术资源的额外成本为770美元；输尿管导管成本为427美元；外科医生成本为383美元。各种妇科手术的每例边际贡献如下：卵巢切除术，盈利2804美元；腹式子宫切除术，盈利2649美元；腹腔镜辅助阴道子宫切除术（LAVH），盈利1760美元。当增加术中输尿管支架置入术时，边际贡献变为：卵巢切除术，盈利782美元；腹式子宫切除术，盈利627美元；LAVH，亏损262美元。总体而言，边际贡献利润从2400美元降至380美元，下降了约85%。
妇科手术中预防性术中输尿管支架置入术会降低医院的边际贡献。鉴于该手术的费用以及科学数据表明其缺乏有效性，作者认为在妇科手术中不应使用预防性术中输尿管支架置入术来减少术中输尿管损伤。
