Clinical and economic impact of implementation of slow shockwave lithotripsy for the treatment of urinary calculi.

Abstract:

AIM:To analyze the impact of slowing the shockwave delivery during extracorporeal shockwave lithotripsy (SWL) on the clinical patient outcome and the cost of delivering this service in a community practice. PATIENTS AND METHODS:The data from 1745 consecutive SWL procedures were analyzed at a freestanding surgery center. About 872 treatments were performed at 120 shocks per minute (fast rate [FR]) and 873 were performed at 60 shocks per minute (slow rate [SR]) using a Lithotron machine. Ninety-nine percent of the patients received 3000 shocks. The location and stone size were similar in both groups. Stone-free rate was determined by a plain film of the abdomen at follow-up. RESULTS:The clinical outcome of SR shows a statistically significant improvement in stone-free rate on all stone locations and stone sizes except for those smaller than 25 mm(2). The need for additional secondary treatment decreased from 35.4% to 18.2%. The anesthesia time increased from 26 to 50 minutes per treatment. On the basis of Medicare reimbursement, there was an increase of $28,294 for anesthesia services by going SR. However, the savings realized as a result of decrease in secondary procedures was $264,989, resulting in a total savings of $236,695 during the study period. The cost savings was $271.13 per SWL treatment. CONCLUSION:The slowing of SWL treatment results in a longer procedure decreasing the time available for treatment; however, the clinical outcome results in improved patient quality of care and decreased cost. Slowing SWL both benefits the patient and decreases the cost of SWL in the community setting.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Kramolowsky EV,Wang G,Butler RM,Wood NL

doi

10.1089/end.2009.0656

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

1483-6

issue

9

eissn

0892-7790

issn

1557-900X

journal_volume

24

pub_type

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