title: Impact of early ureteric stent removal and cost-benefit analysis in kidney transplant recipients: results of a randomized controlled study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Parapiboon
authors.forename: A
authors.initials: A
authors.lastname: Ingsathit
authors.forename: S
authors.initials: S
authors.lastname: Disthabanchong
authors.forename: A
authors.initials: A
authors.lastname: Nongnuch
authors.forename: A
authors.initials: A
authors.lastname: Jearanaipreprem
authors.forename: C
authors.initials: C
authors.lastname: Charoenthanakit
authors.forename: S
authors.initials: S
authors.lastname: Jirasiritham
authors.forename: V
authors.initials: V
authors.lastname: Sumethkul
mesh_terms: D019072:Antibiotic Prophylaxis; D003362:Cost-Benefit Analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D015607:Stents; D013785:Thailand; D013996:Time and Motion Studies; D014513:Ureter
chemical_list: D007166:Immunosuppressive Agents