title: Economic burden of repeat renal surgery on solitary kidney--do the ends justify the means? A cost analysis.
abstract: OBJECTIVE
  Despite the high morbidity of repeat renal surgery in patients with multifocal recurrent renal carcinoma, in most patients adequate renal function is preserved to obviate the need for dialysis. To our knowledge the economic burden of repeat renal surgery has not been evaluated. We provide a cost analysis for patients requiring repeat renal surgery on a solitary kidney.
  
  
  METHODS
  We reviewed the charts of patients treated at the National Cancer Institute who required repeat renal surgery from 1989 to 2010. Functional, oncological and surgical outcomes were evaluated and the costs of repeat renal surgery were calculated. We then compared costs in a cohort of 33 patients who underwent repeat renal surgery on a solitary kidney and in a hypothetical patient cohort treated with uncomplicated nephrectomy, fistula placement and dialysis. All costs were calculated based on Medicare reimbursement rates derived from CPT codes. Cost analysis was performed.
  
  
  RESULTS
  Despite a high 45% complication rate, 87% of patients maintained renal function that was adequate to avoid dialysis and 96% remained metastasis free at an average followup of 3.12 years (range 0.3 to 16.4). Compared to the hypothetical dialysis cohort, the financial benefit of repeat renal surgery was reached at 0.68 years.
  
  
  CONCLUSIONS
  Repeat renal surgery is a viable alternative for patients with multifocal renal cell carcinoma requiring multiple surgical interventions, especially when left with a solitary kidney. Despite the high complication rate, renal function is preserved in most patients and they have an excellent oncological outcome. The financial benefit of repeat renal surgery is reached at less than 1 year.
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Nnenaya Q
authors.initials: NQ
authors.lastname: Agochukwu
authors.forename: Adam R
authors.initials: AR
authors.lastname: Metwalli
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000191:economics* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000191:economics* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000601:surgery*; D009392:Nephrectomy / Q000191:economics*; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies