Is routine ureteral stenting cost-effective in renal transplantation?
OBJECTIVE
Recent collective reviews show that ureteral stenting provides a decrease in ureteroneocystostomy anastomotic complications following renal transplantation. We identified the specific morbidity associated with urinary complications following renal transplantation and quantified the health care resources required to treat these patients at a high volume center.


METHODS
Prospective databases were used to identify patients with a renal transplant who had urinary complications and track postoperative hospital readmissions and admission diagnostic codes. Financial models were used to estimate the variable direct costs of prophylactic stent placement and removal. Cost based analysis was performed to assess the financial feasibility of routine stenting following renal transplantation.


RESULTS
Patient specific morbidity and hospital readmissions were significantly increased in patients with a transplant who had a urinary complication. The incremental hospital costs incurred in a patient with a renal transplant who had urinary leakage during the first 12 months postoperatively was $20,121. Routine placement of an anastomotic stent was inexpensive. Approximately 22 or 23 stents could be placed at the same incremental cost of treating 1 patient with a urinary complication in the hospital.


CONCLUSIONS
Urinary anastomotic complications following renal transplantation are highly morbid. Even with modest decreases in urinary complications prophylactic ureteral stent placement is financially advantageous.
DuBay
Derek A
DA
Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0331, USA.
Lynch
Ray
R
Cohn
Joshua
J
Ads
Yasser
Y
Punch
Jeffrey D
JD
Pelletier
Shawn J
SJ
Campbell
Darrell A
DA
Englesbe
Michael J
MJ
D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D007668:Kidney / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D010359:Patient Readmission / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents / Q000191:economics*; D014513:Ureter / Q000601:surgery; D018666:Ureteroscopy / Q000191:economics* / Q000379:methods; D014552:Urinary Tract Infections / Q000191:economics / Q000517:prevention & control; D014600:Utilization Review / Q000191:economics