Cost analysis of removing pediatric ureteral stents with and without a retrieval string.

Indwelling ureteral stents are commonly placed in urologic surgeries where optimal urinary drainage is necessary. In the pediatric population, removing a stent without retrieval string (SWOS) requires a secondary operation and additional anesthetic exposure. Although these burdens can be mitigated through the placement of a stent with retrieval string (SWS), fears of complications may prevent widespread adoption of this practice by pediatric urologists.

The authors sought to assess the differential cost of removing SWS and SWOS. It was hypothesized that costs associated with removing SWS are significantly lower than those associated with removing SWOS, without increasing complications.

A retrospective chart review was performed on pediatric patients undergoing common urologic surgeries with concurrent stent placement at a single tertiary referral center. Charges and healthcare costs surrounding the removal of ureteral stents were evaluated using the institution-specific ratio of cost to charges, by estimating lost wages, and by exploring differences in poststent healthcare-related events that incur additional cost.

A total of 109 patients with a median age of 5 years (range: 6 months-20 years) were reviewed. A total of 29 patients had SWS, and 80 had SWOS. The theoretical cost of SWS removal in clinic was $400.48 compared with $2290.86 ± $119.30 for operative removal of SWOS, with mean difference of $1890.38 (P < 0.01). The mean stent duration of SWOS was 34.0 ± 13.2 days vs. 10.1 ± 4.9 days for SWS (P < 0.01). Subgroup analysis of the ureteral reconstruction group showed no difference in any complications (35% vs 27%, respectively), early dislodgment (7% vs 7%, respectively) or costly healthcare utilization (23% vs 20%, respectively) among patients with SWOS compared with those with SWS. In SWS group with early dislodgment, neither required a secondary procedure.

With rising healthcare expenditures, physicians must be able to provide cost-effective treatment while not compromising safety or outcomes. Unlike prior analyses of cost related to the type of the stent used, the present study specifically reviewed costs of removing SWS versus SWOS and evaluated rates of costly complications. The study findings provide a preliminary basis for advocating the more economical use of SWS when indicated. Lack of power and heterogeneity of the groups need to be addressed in future analyses with larger, matched cohorts.

Removal of SWS is more cost-effective than that of SWOS while maintaining similar safety outcomes and should be considered in certain pediatric urology cases to decrease healthcare cost. SWS should be preferred for uncomplicated ureteroscopy, but benefits are less certain in ureteral reconstruction; further studies are needed.

Journal of pediatric urology. 2019 Aug 14 [Epub ahead of print]

Hoang-Kim Le, Ryan Gleber, Ruth A Bush, Sarah Marietti, Madhu Alagiri, George Chiang, Kelly Swords

Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA; Section of Pediatric Urology, Baylor Scott & White Health, 2401 S 31st Street, Temple, TX, 76504, USA. Electronic address: ., University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA., Beyster Institute for Nursing Reseach, Hahn School of Nursing, University of San Diego, 5998 Acala Park, San Diego, CA, 92110, USA., Division of Pediatric Urology, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way MC - 5120, San Diego, CA, 92123, USA.