The financial impact of delays to percutaneous nephrolithotomy surgery at a county hospital

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is a standard management for complex renal stone disease. However, the implications of delays in PCNL are under-explored. We hypothesized that increased time prior to intervention in a county hospital system would be associated with higher hospital charges, increased clinic and hospital visits, and increased procedural interventions.

Methods: A single-center retrospective chart review of 132 adult patients undergoing PCNL at a county hospital from April 2019 to December 2022 was performed. Groups were organized based on time from diagnosis to surgery (<4 months, 4–6 months, >6 months). Key outcomes included hospital charges, insurance types, ureteral stent versus nephrostomy decompression, presence of stent encrustation, and number of preoperative computed tomography (CT) scans, emergency department (ED) visits, and interventions. Kruskal–Wallis ANOVA was used for determining group differences between continuous variables, and χ² was used for categorical variables.

Results: A total of 132 PCNLs were analyzed with a median diagnosis-to-operating room (OR) period of 135 days. Compared to patients with diagnosis-to-OR period less than 4 months, those with PCNL performed in 4–6 months and over 6 months had 7% and 36% higher hospital charges respectively ($27607vs.$29 416 vs. $37 622, p = 0.018). Delays to PCNL surgery resulted in more CT scans (p = 0.019), clinic visits (p < 0.001), and interventions (p = 0.003).

Conclusion: Our study showed that in a medically underserved population, increased diagnosis-to-OR period led to increased healthcare utilization, additional procedures, and hospital charges. Changes aimed at reducing the time from diagnosis to surgery could reduce the financial burden for both patients and the healthcare system.

Keywords

adult urology / calculus disease / delays / financial / percutaneous nephrolithotomy

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