Parapiboon W, Ingsathit A, Disthabanchong S, Nongnuch A, Jearanaipreprem A, Charoenthanakit C, Jirasiritham S, Sumethkul V
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2012 Apr;44(3):737-9. doi: 10.1016/j.transproceed.2011.11.033.
Duration of retaining ureteric stent in kidney transplantation is still controversial. Our study aimed to compare healthcare expenditures in kidney transplant recipients with early or routine ureteric stent removal.
This study was a post hoc analysis of data from a single-center parallel randomized controlled open-label study. Ninety patients who underwent kidney transplantation at a university-based hospital in Thailand from April 2010 to January 2011 were enrolled. Patients were randomized to early ureteric stent removal (8 days) or routine ureteric stent removal (15 days) after kidney transplantation. The costs of direct health care associated with kidney transplantation, urologic complication, and urinary tract infection (UTI) within the postoperative period among the 2 groups were compared.
Seventy-four patients (58% living donor) fulfilled the randomized criteria (early removal, n = 37; routine removal, n = 37). By intention-to-treat analysis, incidence of UTI in early stent removal was less than the routine stent removal group (15/37, 40.5% vs 27/37, 72.9%; P = .004). Urologic complication showed no significant difference between the early and routine groups (4/37 vs 2/37; P = .39). The cost-benefit analysis of early over routine stent removal was 2390 United States dollars (USD) per patient (11,182 vs 8792 USD). Presence of UTI significantly increase the hospitalization cost of 5131 USD per patient (mean cost = 12,209 vs 7078 USD; P < .001).
UTI in the early post-kidney transplantation period increases healthcare cost. Early ureteric stent removal can reduce UTI and reduce hospitalization cost. This approach shows cost-benefit in the early management of kidney transplant recipients.
肾移植中输尿管支架的留置时间仍存在争议。我们的研究旨在比较早期或常规取出输尿管支架的肾移植受者的医疗费用。
本研究是对一项单中心平行随机对照开放标签研究的数据进行的事后分析。纳入了2010年4月至2011年1月在泰国一家大学医院接受肾移植的90例患者。患者被随机分为肾移植后早期取出输尿管支架（8天）或常规取出输尿管支架（15天）。比较了两组术后与肾移植、泌尿系统并发症和尿路感染（UTI）相关的直接医疗费用。
74例患者（58%为活体供肾）符合随机标准（早期取出组，n = 37；常规取出组，n = 37）。按意向性分析，早期取出支架组的UTI发生率低于常规取出支架组（15/37，40.5%对27/37，72.9%；P = .004）。早期组和常规组的泌尿系统并发症无显著差异（4/37对2/37；P = .39）。早期取出支架相对于常规取出支架的成本效益分析为每位患者2390美元（11,182美元对8792美元）。UTI的存在显著增加了每位患者5131美元的住院费用（平均费用 = 12,209美元对7078美元；P < .001）。
肾移植术后早期的UTI会增加医疗费用。早期取出输尿管支架可降低UTI并降低住院费用。这种方法在肾移植受者的早期管理中显示出成本效益。
