title: Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy.
abstract: OBJECTIVE
  To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy (PCNL) and to determine which method can be performed at a lower cost per case.
  
  
  METHODS
  A cost comparison study was performed utilizing clinical data from a prospectively maintained research database. We included the most recent 33 consecutive ultrasound-guided PCNL cases in 2016 and the most recent 40 consecutive fluoroscopy-guided PCNL cases before the operative surgeon transitioned to ultrasound guidance in May 2014. The total operative time and clinical outcomes were examined. Costs were extracted from the institution accounting systems and given a uniform multiplier to protect institutional financial reporting confidentiality. Comparisons were made using the Student t test and the chi-squared test.
  
  
  RESULTS
  After excluding outliers, 71 PCNL procedures were included in the analysis. Demographic data and stone characteristics were not different between ultrasound-guided and fluoroscopy-guided groups. However, the mean operative time for ultrasound-guided PCNL was significantly shorter (99.8 ± 27.0 vs 144.9 ± 55.1 minutes, P < .05). When capital equipment costs were included, the mean total cost per case of ultrasound-guided PCNL was approximately 30% less than fluoroscopy-guided PCNL (simulated costs with a uniform multiplier; $5258.90 ± 957.12 vs $7508.60 ± 1163.83, P < .05). Postoperative clinical outcomes were comparable between the 2 groups.
  
  
  CONCLUSIONS
  When capital costs are included, ultrasound-guided PCNL can produce comparable clinical outcomes to fluoroscopy-guided procedures at a lower cost to the institution. Shorter operative time drives significant savings with the adoption of ultrasound guidance, which may be magnified with increasing case volume. Using ultrasound imaging during PCNL may be more cost-effective compared to fluoroscopy and warrants further study.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hudnall
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA; Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Manint
authors.initials: M
authors.lastname: Usawachintachit
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Ian
authors.initials: I
authors.lastname: Metzler
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: David T
authors.initials: DT
authors.lastname: Tzou
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Harrison
authors.affiliation: Department of Anesthesia, University of California, San Francisco, San Francisco, CA.
authors.forename: Errol
authors.initials: E
authors.lastname: Lobo
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: tom.chi@ucsf.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chi
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D005471:Fluoroscopy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D000074642:Nephrolithotomy, Percutaneous / Q000191:economics*; D061646:Operative Time; D011446:Prospective Studies; D014463:Ultrasonography; D014965:X-Rays