Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy

Abstract

Objective To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy (PCNL) and determine which method can be performed at a lower cost per case. Methods A cost comparison study was performed utilizing clinical data from a prospectively maintained research database. We included the most recent 33 consecutive ultrasound-guided PCNL cases in 2016 and the most recent 40 consecutive fluoroscopy-guided PCNL cases before the operative surgeon transitioned to ultrasound guidance in May 2014. Total operative time and clinical outcomes were examined. Costs were extracted from the institution accounting systems and given a uniform multiplier to protect institutional financial reporting confidentiality. Comparisons were made using Student’s t-test and Chi-squared. Results After excluding outliers, 71 PCNL procedures were included in the analysis. Demographic data and stone characteristics were not different between ultrasound-guided and fluoroscopy-guided groups. However, mean operative time for ultrasound-guided PCNL was significantly shorter (99.8±27.0 vs. 144.9±55.1 minutes, p <0.05). Including capital equipment costs, the mean total cost per case of ultrasound-guided PCNL was approximately 30% less than fluoroscopy-guided PCNL (simulated costs with a uniform multiplier; $5,258.90±957.12 vs. $7,508.60±1,163.83, p <0.05). Postoperative clinical outcomes were comparable between the two groups. Conclusion Including capital costs, ultrasound-guided PCNL can produce comparable clinical outcomes to fluoroscopy-guided procedures at a lower cost to the institution. Shorter operative time drives significant savings with the adoption of ultrasound guidance, which may be magnified with increasing case volume. Using ultrasound imaging during PCNL may be more cost-effective compared to fluoroscopy and warrants further study.

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

“…Furthermore, in a recent study Hudnall et al [40] analyzed 71 consecutive PCNL performed using either USGA or FGA finding a mean reduction of overall costs of 30% when using USGA, which makes the ultrasound approach even more appealing.…”

Ultrasound guidance can be used safely for renal tract dilatation during percutaneous nephrolithotomy

“…This exposure may therefore be clinically significant over the course of a lifetime for both patients and practitioners. Second, we previously described the cost savings associated with the substitution of fluoroscopy for ultrasonography during the renal puncture . By further reducing the need for fluoroscopy by incorporating ultrasonography during dilatation, there is potential for even greater cost savings.…”

“…Once access to the collecting system is established, surgeons face the additional decision of performing dilatation with or without fluoroscopic imaging guidance. In previous studies, we have demonstrated ultrasonography‐guided renal puncture and its advantages over fluoroscopy in reducing both cost and radiation exposure for patients . While we have previously published a study on the feasibility of using ultrasonography to guide both renal tract access and dilatation , to the best of our knowledge, a comparison between fluoroscopy‐ and ultrasonography‐guided dilatation specifically has not been examined in the urology literature.…”

X-ray-free ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a comparative study with historical control

“…The use of XG-PCNL could also increase the number of provided PCNL procedures especially in the peripheral area, given the higher rate of ultrasound device availability in most peripheral hospitals. The total cost for every case of XG-PCNL was also approximately 30% less than the fluoroscopy-guided (FG)-PCNL [5].…”