Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis.
OBJECTIVE
Iatrogenic ureteral injury during gynaecological surgery is associated with increased morbidity when not diagnosed during the initial surgery. Preoperative insertion of ureteral catheters may enhance intraoperative recognition of injury and repair, but it is controversial. We sought to analyse the costs of this approach. DESIGN/SETTING/POPULATION: A decision-tree analysis of clinical scenarios of using universal ureteral catheterisation compared with no catheterisation was conducted for benign abdominal hysterectomy and radical hysterectomy.


METHODS
Diagnostic-Related Groups and Current Procedural Terminology coding and reimbursement information were used as calculated for Medicare patients in the USA.


METHODS
Differences in projections of total hospital-related costs related to clinical scenarios of perioperative care for women undergoing hysterectomy with or without ureteral catheterisation.


RESULTS
Universal ureteral catheterisation is cost saving when the rate of ureteral injury during benign abdominal hysterectomy or radical hysterectomy is greater than 3.2%.


CONCLUSIONS
The cost savings of universal ureteral catheterisation at hysterectomy depend on the injury rate but are minimal at common levels of injury.
Schimpf
M O
MO
Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT, USA. mschimp@harthosp.org
Gottenger
E E
EE
Wagner
J R
JR
D017046:Cost Savings; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005249:Fees and Charges; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000191:economics; D015607:Stents / Q000009:adverse effects* / Q000191:economics; D014513:Ureter / Q000293:injuries*; D014546:Urinary Catheterization