Key Challenges of OR-Based Ureteral Stenting for Kidney Stones
Learn why stent placement in the operating room results places an enormous cost, time, and resource burden for the patient and healthcare system.
Acute Renal Colic is an excruciatingly painful condition that results in about 1.2 million people seeking medical care annually. The primary care pathway involves an emergency ureteral stenting procedure typically performed in the operating room under general anaesthesia.
With operating room availability and general anaesthesia coming into the picture, a patient in the grips of a kidney stone pain attack may be required to endure a waiting time of up to 2 days. To make matters worse, the total cost for an otherwise short surgical procedure averages a staggering $16,000.
In this blog, we explore why stent placement in the operating room results in an enormous cost, time, and resource burden for the patient and healthcare system.
Top 5 Challenges Associated With OR-Based Ureteral Stenting
OR-based ureteral stent placement involves the use of cystoscopic instruments, fluoroscopy, and general anaesthesia or sedation. However, the hospital workload and the multi-faceted nature of this care pathway lead to a significant strain on time, cost, and resources.
According to medical literature and the expertise of the JiffyStent team, these are the top 5 challenges plaguing OR-based stent placements.
Lengthy Wait Time
A renal colic patient seeking emergency healthcare facilities is admitted to the hospital and required to fast for a minimum of 6 hours. How quickly they receive surgical intervention depends on the emergency operation waitlist and the availability of a multi-disciplinary medical team, including an anaesthesiologist, to administer the general anaesthesia.
In centres with high patient volumes needing emergency surgeries, kidney stone pain cases without infection may be rescheduled for more critical cases. This delays the time to stent placement with a waiting that can span up to 2 days.
Prolonged Pain
Acute renal colic attack is an anguishingly painful condition caused by a stone stuck in the urinary tract, triggering a sudden onset of intense flank pain. The pain originates over the costovertebral angle, radiating all the way to the groin and testicles. In several cases, renal colic is accompanied by nausea and vomiting.
According to medical literature, between 1% and 15% of the population will be impacted by kidney stone disease at some point in their lives. About 80% of those who visit the hospital are sent back home to pass the stone naturally. As for patients suitable for emergency surgical intervention, the wait for pain relief can be agonisingly long.
Cost
We used data from two studies (Gershman et al. and Sivalingam et al.) to perform a cost analysis, pegging the average cost of an OR-based ureteral stenting to be about $16000. The main cost contributors included operating room time, anaesthesiology charges, postanaesthesia care unit charges, ED charges, preoperative imaging, laboratory testing, medications, etc.
In addition to financial costs, operating room-based stent placement also results in significant opportunity costs. It adds to the workload of an already overwhelmed emergency department, demanding limited resources that can otherwise be allocated to more critical cases.
Longer Hospital Stay
A patient scheduled to undergo an OR-based stent placement is required to report several hours ahead of the procedure as well as fast for a minimum of 6 hours. Since an OR waitlist is typically managed by a triage system, the surgery may get postponed or rescheduled, requiring the patient to go through a repetitive cycle of fasting, eating, and waiting.
The periprocedure care, as well as the time spent recovering from general anaesthesia, also adds to the total hospital time. According to a study, the periprocedure waiting time of an OR-based stent placement was 226.4–21.6 minutes, p<0.001.
Risks Associated with General Anaesthesia
Ureteral stenting is a common urological procedure, but it is not without risks, especially when conducted under general anaesthesia. The side effects associated with general anaesthesia range from cardiorespiratory complications and deep vein thrombosis to overall lethargy. The risk of complications is especially high for the elderly, obese, or patients with cardiovascular comorbidities.
Making Ureteral Stenting Safer, Quicker, and More Cost-effective
Every year, one in two hundred people will be affected by kidney stone pain. Given the widespread prevalence of this painful condition, there’s a need for a quicker, less invasive, and more cost-effective care pathway.
JiffyStent is currently developing an office-based stenting device that will allow urologists and patients to bypass the hurdles associated with operating room stent insertion. Follow us on LinkedIn and stay up to date as we revolutionise care for kidney stone pain.
References: