Mp78-10 Utilization and Cost of Outpatient Percutaneous Nephrolithotomy in the United States

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) V (MP78)1 May 2024MP78-10 UTILIZATION AND COST OF OUTPATIENT PERCUTANEOUS NEPHROLITHOTOMY IN THE UNITED STATES Adithya Balasubramanian, Richard Berman, Justin Lee, Leo D. Dreyfuss, Xian Wu, Jonathan Shoag, and Ojas Shah Adithya BalasubramanianAdithya Balasubramanian , Richard BermanRichard Berman , Justin LeeJustin Lee , Leo D. DreyfussLeo D. Dreyfuss , Xian WuXian Wu , Jonathan ShoagJonathan Shoag , and Ojas ShahOjas Shah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008856.05210.73.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large or complex renal stones. New PCNL techniques have increased interest in reducing hospitalization times and costs, as well as treating smaller stones. We analyzed the utilization, regional adoption, and costs of outpatient and inpatient PCNL in the United States (US) using a large nationally representative cohort. METHODS: Patients undergoing PCNL between 2016 and 2019 were retrospectively identified via ICD-10-PCS and CPT procedure codes in the Premier Healthcare Database. Outpatient PCNL was defined as a discharge within 23 hours of the procedure while inpatient PCNL as a hospital admission beyond 24 hours. Demographic and clinical data including direct hospital costs (in 2022 US dollars) and Charlson Comorbidity Index (CCI) were reported. Wilcoxon Rank Sum and Chi Squared tests were used to compare differences between inpatient and outpatient PCNL. Logistic regression was performed to identify factors associated with undergoing outpatient PCNL. RESULTS: A total of 22,815 PCNLs were captured over the study period. Of these, 43% (9,792) were outpatient while 57% (13,023) were inpatient. Median age of included patients was 59 (Interquartile Range (IQR): 46-68) years. Median hospital stay for inpatient PCNL was 2 (IQR:1-4) days. Mean CCI amongst patients undergoing inpatient PCNL was higher than CCI for outpatient PCNL patients (1.08 versus 0.7, p<0.001). Inpatient PCNL incurred more direct hospital costs when compared to outpatient PCNL ($19,578 versus $10,587, p<0.001). Logistic regression revealed that patients who were female (odds ratio (OR) 0.86, 95% confidence interval (95%CI) 0.8 to 0.92), African American (OR 0.8, 95%CI 0.69 to 0.93), lived in rural regions (OR 0.79, 95%CI 0.7 to 0.9) or had a higher CCI (OR 0.76, 95%CI 0.73 to 0.78) were less likely to undergo outpatient PCNL. The proportion of outpatient PCNLs increased across the study period from 52% to 63% (Figure 1). CONCLUSIONS: The majority of PCNLs are performed as an outpatient surgery and associated with substantively lower costs. Inpatient PCNL remains commonly performed though, particularly among patients with more comorbidities. Download PPT Source of Funding: JES is supported by the Frederick J. and Theresa Dow Fund of the New York Community Trust, the Vinney Scholars Award, and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1267 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Adithya Balasubramanian More articles by this author Richard Berman More articles by this author Justin Lee More articles by this author Leo D. Dreyfuss More articles by this author Xian Wu More articles by this author Jonathan Shoag More articles by this author Ojas Shah More articles by this author Expand All Advertisement PDF downloadLoading ...