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Costs analysis of laparoendoscopic, single-site laparoscopic and open surgery for cT1 renal masses in a European high-volume centre

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Abstract

Objective

To analyse intraoperative costs and healthcare reimbursements of partial/radical nephrectomy in open and minimal invasive surgery (MIS), as laparoscopy and laparoendoscopic single-site surgery (LESS), for the treatment of renal tumour.

Materials and methods

In a non-randomized retrospective study, we selected 90 patients who underwent (01/2010–12/2011) partial and radical nephrectomy for clinical renal masses ≤7 cm (cT1N0M0) and divided them into laparoscopic [laparoscopic partial nephrectomy (LPN), laparoscopic radical nephrectomy (LRN)], LESS [laparoendoscopic single-site partial nephrectomy (LESS-PN), laparoendoscopic single-site radical nephrectomy (LESS-RN)] and open groups [open partial nephrectomy (OPN), open radical nephrectomy (ORN)]. Patients were matched for age, sex, body mass index, ASA score and tumour side. Primary endpoints were evaluation of intraoperative costs (general, laparoscopic, sutures, haemostatic agents, anaesthesia, and surgeon/nurses fee), total insurance and estimated daily reimbursement.

Results

MIS showed longer operative time (p ≤ .02) and shorter hospital stay (p ≤ .04). Total costs were higher (p ≤ .03) in MIS (LRN: 4,091.5 €; LPN: 4,390.4 €; LESS-RN: 3,866 €; and LESS-PN: 3,450 €) if compared with open (OPN: 2,216.8.8 €, ORN: 1,606.4 €). Laparoscopic materials incised mainly in total costs of MIS (38–58.1 %). Reusable instruments reduced LESS laparoscopic costs (LESS-PN: 1,312.2 € vs. LRN: 2,212.2 €, p < .0001). Intraoperative frozen section and DJ ureteric stenting (general costs) (p ≤ .008) and haemostatic agents use (p ≤ .01) were higher in nephron sparing surgery (NSS), due to more frequent use of ancillary procedures necessary for a safe management of such an approach. Estimated anaesthesia costs and doctor/nurses fee were higher in MIS (p ≤ .02). Whereas total final reimbursements were comparable (p ≥ .8), estimated daily reimbursements were lower in MIS (p < .001) due to higher intraoperative costs and longer operative time.

Conclusion

Well-known advantages offered by MIS/NSS face higher total intraoperative costs and ‘paradoxical’ reduced healthcare reimbursement. We believe that local health systems should consider a subclassification with different compensations, which will incentive NSS and MIS approaches.

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Abbreviations

MIS:

Minimally invasive surgery

RN:

Radical nephrectomy

RCC:

Renal cell carcinoma

NSS:

Nephron sparing surgery

SRM:

Small renal masses

LESS:

Laparoendoscopic single-site surgery

G-DRG:

German diagnosis-related groups

ORN:

Open radical nephrectomy

OPN:

Open partial nephrectomy

LRN:

Laparoscopic radical nephrectomy

LPN:

Laparoscopic partial nephrectomy

LESS-RN:

Laparoendoscopic single-site surgery radical nephrectomy

LESS-PN:

Laparoendoscopic single-site surgery partial nephrectomy

LoS:

Length of stay

ASA:

American Society of Anesthesiology

BMI:

Body mass index

DJ:

Double-J catheter

References

  1. Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406. doi:10.1016/j.eururo.2010.06.032

    Article  PubMed  Google Scholar 

  2. Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279. doi:10.1016/j.juro.2009.07.004

    Article  PubMed  Google Scholar 

  3. Van Poppel H, Da Pozzo L, Albrecht W et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 51:1606–1615. doi:10.1016/j.eururo.2006.11.013

    Article  PubMed  Google Scholar 

  4. Cooperberg MR, Mallin K, Kane CJ et al (2011) Treatment trends for stage I renal cell carcinoma. J Urol 186:394–399. doi:10.1016/j.juro.2011.03.130

    Article  PubMed  Google Scholar 

  5. Touijer K, Jacqmin D, Kavoussi LR et al (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57:214–222. doi:10.1016/j.eururo.2009.10.019

    Article  PubMed  Google Scholar 

  6. Springer C, Hoda MR, Fajkovic H, Pini G, Mohammed N, Fornara P, Greco F (2012) Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 340 patients. BJU Int. doi:10.1111/j.1464-410X.2012.11280.x

  7. Autorino R, Kaouk JH, Yakoubi R, Rha KH, Stein RJ, White WM et al (2012) Urological laparoendoscopic single site surgery: multi-institutional analysis of risk factors for conversion and postoperative complications. J Urol 187(6):1989–1994. doi:10.1016/j.juro.2012.01.062

    Article  PubMed  Google Scholar 

  8. Cindolo L, Greco F, Fornara P, Mirone V, Schips L (2012) Nephron sparing LESS: technique and review of the current literature. Arch Esp Urol 65(3):303–310

    PubMed  Google Scholar 

  9. Doublet JD, JAteschek G, Joyce A, Mandressi A, Rassweiler J. Tolley D (2003) Guideline on laparoscopy. Eur Urol. http://www.ourologosandrologos.gr/docs/laparoscopy.pdf

  10. Herwartz H, Strumann C (2012) On the effect of prospective payment on local hospital competition in Germany. Health Care Manag Sci 15:48–62. doi:10.1007/s10729-011-9180-9

    Article  PubMed  Google Scholar 

  11. Volkmer BG, Petschl S, Rieder M, Fichtner J, Pühse G, Kleinschmidt K, Simon J (2008) The German diagnosis-related groups in urology: reproducibility and quality of coding. Urologe A 47(3):304–313. doi:10.1007/s00120-007-1571-7

    Article  CAS  PubMed  Google Scholar 

  12. Tanagho YS, Figenshau RS, Sandhu GS, Bhayani SB (2012) Is there a financial disincentive to perform partial nephrectomy? J Urol 157:1995–1999. doi:10.1016/j.juro.2012.01.120

    Article  Google Scholar 

  13. Greco F, Hoda MR, Mohammed N, Springer C, Fischer K, Fornara P (2012) Laparoendoscopic single-site and conventional laparoscopic radical nephrectomy result in equivalent surgical trauma: preliminary results of a single-centre retrospective controlled study. Eur Urol 61(5):1048–1053. doi:10.1016/j.eururo.2012.01.043

    Article  PubMed  Google Scholar 

  14. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474. doi:10.1245/s10434-010-0985-4

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. doi:10.1097/01.sla.0000133083.54934.ae

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hoda MR, Fornara P (2012) Nephrectomy—pro laparoscopic. Urologe A 51(5):658–665. doi:10.1007/s00120-012-2862-1

    Article  CAS  PubMed  Google Scholar 

  17. Greco F, Veneziano D, Wagner S, Kawan F, Mohammed N, Hoda MR, Fornara P (2012) Laparoendoscopic single-site radical nephrectomy for renal cancer: technique and surgical outcomes. Eur Urol 62(1):168–174. doi:10.1016/j.eururo.2011.10.002

    Article  PubMed  Google Scholar 

  18. Minervini A, Serni S, Tuccio A, Siena G, Vittori G, Masieri L, Giancane S, Lanciotti M, Khorrami S, Lapini A, Carini M (2012) Simple enucleation versus radical nephrectomy in the treatment of pT1a and pT1b renal cell carcinoma. Ann Surg Oncol 19:694–700. doi:10.1245/s10434-011-2003-x

    Article  PubMed  Google Scholar 

  19. Nguyen MM, Gill IS (2008) Halving ischemia time during laparoscopic partial nephrectomy. J Urol 179(2):627–632. doi:10.1016/j.juro.2007.09.086 discussion 632

    Article  PubMed  Google Scholar 

  20. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59(4):543–552. doi:10.1016/j.eururo.2010.12.013

    Article  PubMed  Google Scholar 

  21. Sun M, Becker A, Tian Z, Roghmann F, Abdollah F, Larouche A, Karakiewicz PI, Trinh QD (2013) Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol. doi:10.1016/j.eururo.2013.03.034

    Google Scholar 

  22. Fornara P, Doehn C, Seyfarth M, Jocham D (2000) Why is urological laparoscopy minimally invasive? Eur Urol 37(3):241–250

    Article  CAS  PubMed  Google Scholar 

  23. Jemal A, Siegel R, Xu J et al (2010) Cancer statistics. CA Cancer J Clin 2010(60):277–300. doi:10.3322/caac.20073

    Article  Google Scholar 

  24. Dulaben LM, Lawrence WT, Russo P et al (2010) Trends in renal tumor surgery delivery within the United States. Cancer. 15; 116(10):2316-2321. doi:10.1002/cncr.24965

    Google Scholar 

  25. Becker A, Roghmann F, Trinh QD, Hansen J, Tian Z, Shariat SF, Noldus J, Perrotte P, Graefen M, Karakiewicz PI, Sun M (2013) Sociodemographic disparities in the treatment of small renal masses. BJU Int 111(8):E274–E282. doi:10.1111/bju.12111

    Article  PubMed  Google Scholar 

  26. Guazzoni G, Cestari A, Naspro R, Riva M, Rigatti P (2006) Cost containment in laparoscopic radical nephrectomy: feasibility and advantages over open radical nephrectomy. J Endourol 20:509–513. doi:10.1089/end.2006.20.509

    Article  PubMed  Google Scholar 

  27. Bartkowski R (2012) Length of hospital stay due to DRG reimbursement. Ther Umsch 69(1):15–21. doi:10.1024/0040-5930/a000245

    Article  PubMed  Google Scholar 

  28. Lang H, Mouracade P, Gimel P, Bernhard J, Pignot G et al (2013) National prospective study on the use of local haemostatic agents during partial nephrectomy. BJU Int. doi:10.1111/bju.12397

  29. Sprenkle PC, Power N, Ghoneim T, Touijer KA, Dalbagni G, Russo P, Coleman JA (2012) Comparison of open and minimally invasive partial nephrectomy for renal tumors 4–7 centimeters. Eur Urol 61(3):593–599. doi:10.1016/j.eururo.2011.11.040

    Article  PubMed  Google Scholar 

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Conflict of interest

All authors disclose any commercial associations that might create a conflict of interest in connection with the submitted manuscript.

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Authors and Affiliations

  1. Department of Urology and Kidney Transplantation Centre, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, 06120, Halle/Saale, Germany

    Giovannalberto Pini, Luigi Ascalone, Francesco Greco, Nasreldin Mohammed & Paolo Fornara

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  1. Giovannalberto Pini
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  2. Luigi Ascalone
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  3. Francesco Greco
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  4. Nasreldin Mohammed
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  5. Paolo Fornara
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Correspondence to Giovannalberto Pini.

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Pini, G., Ascalone, L., Greco, F. et al. Costs analysis of laparoendoscopic, single-site laparoscopic and open surgery for cT1 renal masses in a European high-volume centre. World J Urol 32, 1501–1510 (2014). https://doi.org/10.1007/s00345-013-1223-z

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  • DOI: https://doi.org/10.1007/s00345-013-1223-z

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