title: Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.
abstract: BACKGROUND
  Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost.
  
  
  OBJECTIVE
  To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.
  
  
  METHODS
  All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed.
  
  
  RESULTS
  Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380.
  
  
  CONCLUSIONS
  Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as scientific data suggesting a lack of effectiveness, the authors argue that prophylactic intraoperative ureteral stenting should not be used in gynecologic surgery to decrease operative ureteric injury.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Pennsylvania State University Milton S. Hershey Medical Center, 500 University Dr, Room C-3620, Hershey, PA 17033-2360, USA. jfanning1@hmc.psu.edu
authors.forename: James
authors.initials: J
authors.lastname: Fanning
authors.forename: Bradford
authors.initials: B
authors.lastname: Fenton
authors.forename: Geraldine Marie
authors.initials: GM
authors.lastname: Jean
authors.forename: Clara
authors.initials: C
authors.lastname: Chae
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003558:Cystoscopy / Q000191:economics* / Q000295:instrumentation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics* / Q000295:instrumentation; D006801:Humans; D007297:Inpatients; D007430:Intraoperative Care / Q000191:economics* / Q000295:instrumentation; D008875:Middle Aged; D010414:Pennsylvania; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*; D014513:Ureter / Q000601:surgery*