Prospective cost-analysis of laparoscopic vs open pyeloplasty in children: single center comtemporary evaluation of two procedures over a 1-year period

PurposeLaparoscopy in pediatric urological surgery continues to grown in acceptance. Even though economic implications are of increasing importance, few studies have compared the expense associated with open (OA) and laparoscopic (LP) approaches. Herein we present a prospective comparative cost-analysis between the laparoscopic and open approaches for pediatric pyeloplasty.Material and MethodsBetween April 2007 and March 2008, 54 consecutives pyeloplasties were performed. This timeframe is past our initial laparoscopic experience, thus beyond the learning-curve period. The “traditional” OA was performed for 33 patients and the remaining 21 children underwent LP, depending on surgeon's preference. Costs were prospectively collected for each group and divided based on amounts incurred by all different departments involved (nursing, laboratory, diagnostic imaging, pharmacy, operative room).ResultsOverall, the average cost for a LP was CDN$6240 compared to CDN$5079 for an OA with a median hospital stay of 2 days for both groups (Range OA:1-18, LP:1-7). Nursing care was more expensive for OA (CDN$1999 vs. LP:CDN$1716). Pharmacy, diagnostic imaging and laboratory costs were equivalent for the two approaches. The main difference found was in operative room expenses (OA:CDN$2508 vs. LP:CND$3925). The higher cost could not be solely explained by the use of the disposable items, which only subtracts CDN$335 per procedure (23.6% of the cost difference between OA and LP). Length of time spent in the operating room was 1.2hours longer for the laparoscopic cases and appears to be the main factor explaining the cost difference.ConclusionsOur findings show that in our institution pediatric LP is more expensive than the OA. This cost difference is mainly due to operating room time. For cost-containment purposes, efforts aimed at increasing efficiency in the operating room may help equalize both approaches form an economic point of view.