title: Endobronchial ultrasonography versus mediastinoscopy: a single-institution cost analysis and waste comparison.
abstract: BACKGROUND
  Mediastinoscopy (MED) and endobronchial ultrasonography with transbronchial needle aspiration (EBUS-TBNA) have similar accuracy for mediastinal lymph node sampling (MLNS). The threatened financial and environmental sustainability of our health care system mandate that surgeons consider cost and environmental impact in clinical decision making of similarly effective procedures. We performed a cost and waste comparison of MED versus EBUS-TBNA for MLNS to raise awareness of the financial and environmental implications of our practices.
  
  
  METHODS
  We conducted a retrospective review of outpatients who underwent MLNS under general anesthesia in the OR with MED or EBUS-TBNA (September 2007 to December 2009). We analyzed direct costs based on hospital charges, calculated expected payment using a decision support model, and profit margins (modeled expected payment-direct costs). Our waste comparison was measured in kilograms of solid waste per case.
  
  
  RESULTS
  We performed MLNS in 148 patients (89 EBUS-TBNA, 39 MED, 20 EBUS + MED). Direct costs were lower for MED ($2,356) compared with EBUS-TBNA ($2,503), whereas expected payment was greater (MED, $3,449; EBUS-TBNA, $3,249), resulting in a profit margin that was $347 greater for MED. The amount of solid waste for each MED was 1.8 kg versus 0.5 kg for EBUS-TBNA.
  
  
  CONCLUSIONS
  MED costs less than EBUS-TBNA in the OR setting but generates 3.6 times the amount of EBUS-TBNA waste. The cost of EBUS-TBNA may improve by performance in the endoscopy suite, and surgical pack revision could reduce the amount of MED solid waste. This comparison sets the stage for sophistication of our clinical decision making, taking into consideration the major threats to our health care system.
authors.affiliation: Section of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: andr0119@umn.edu.
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Andrade
authors.affiliation: Section of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Eitan
authors.initials: E
authors.lastname: Podgaetz
authors.affiliation: Section of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rueth
authors.affiliation: Section of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Kaustav
authors.initials: K
authors.lastname: Majumder
authors.affiliation: Financial Offices, Fairview Health Services, Minneapolis, Minnesota.
authors.forename: Eric
authors.initials: E
authors.lastname: Hall
authors.affiliation: Waste Services and Waste Reduction, Fairview Health Services, Minneapolis, Minnesota.
authors.forename: Crystal
authors.initials: C
authors.lastname: Saric
authors.affiliation: University of Minnesota Operating Room, Fairview Health Services, Minneapolis, Minnesota.
authors.forename: Lynn
authors.initials: L
authors.lastname: Thelen
mesh_terms: D001999:Bronchoscopy / Q000191:economics*; D003365:Costs and Cost Analysis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000191:economics*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008481:Mediastinoscopy / Q000191:economics*; D008506:Medical Waste / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D008506:Medical Waste