Prospective cost analysis of laparoscopic vs. open pyeloplasty in children: Single centre contemporary evaluation comparing two procedures over a 1-year period.

INTRODUCTION

Laparoscopy in pediatric urological surgery continues to gradually gain acceptance. Since economic implications are of increasing importance in our cost-containment environment, few studies have compared the expense associated with open to laparoscopic approaches. We present a prospective comparative cost-analysis between the laparoscopic (LP) and open pediatric pyeloplasty (OP).

METHODS

Over a period of a year (2007-2008), 54 consecutives pyeloplasties were performed. The "traditional" OP was performed in 33 patients and the remaining 21 children underwent LP. Costs were prospectively collected for each group and divided based on amounts incurred by all different departments involved: nursing, laboratory, diagnostic imaging, pharmacy and operative room.

RESULTS

Overall, the average cost for a LP was CDN$6240 compared to CDN$5079 for an OP with a median hospital stay of 2 days (range OP: 1-18, LP: 1-7). The main difference was found in operative room expenses (OP: $2508 vs. LP: $3925). The higher cost could not be solely explained by the use of disposable items, which only subtracts $335 per procedure (23.6% of the cost difference between OP and LP). Length of time spent in the operating room was 1.2 hours longer for the LP and appears to be the main factor explaining the cost difference.

CONCLUSION

Our findings show that at our institution, pediatric LP is more expensive than OP. This cost difference is mainly due to operating room time. For cost-containment purposes, efforts aimed at increasing efficiency in the operating room may help equalize both approaches.