Percutaneous Nephrostolithotomy: An Assessment of Costs for Prone and Galdakao-modified Supine Valdivia Positioning

ObjectiveTo examine the relative costs of prone percutaneous nephrostolithotomy (PCNL) versus PCNL performed with the patient in the Galdakao-modified supine Valdivia (GMSV) position to determine whether a cost differential exists.MethodsWe compared prone PCNL with PCNL using GMSV positioning. Cost data were obtained from the urology departmental and hospital billing offices at our institution and from the 2011 local Medicare reimbursement scales. The costs were divided into 5 major categories: surgeon fees, anesthesia fees, surgical supplies, hospital-related fees, and lost revenue.ResultsThe overall cost of prone PCNL ranged from $23 423 to $24 463, and the cost for PCNL performed with GMSV positioning ranged from $24 725 to $25 830. The difference between the 2 positions ranged from approximately $1302 for stones ≤2 cm to $1367 for stones >2 cm. The lost office revenue because of the requirement for a second surgeon was estimated at $1987.ConclusionOur assessment of the cost for prone versus GMSV PCNL technique found GMSV positioning to be more costly. The presence of 2 surgeons was the main driver of the cost differential, because it resulted in more equipment use, with greater instrument repair costs and higher surgeon fees. It also brings into consideration the opportunity cost of having a second surgeon in the operating room and not in the office.