Abstract
The authors in this interesting study demonstrated that operative time was the main driver for the increased costs associated with ureteroscopy. 1 Factors associated with increased operative time were stone burden and the presence of a resident. The authors did not go into detail into the decision-making process if stone fragmentation and basket extraction vs dusting was the primary mode of stone treatment and if the goal was to achieve a stone-free status.
The authors did not go into great detail about what the role of the resident was during the case. It was interesting that the study demonstrated no difference in cost based on the level of training but only if a resident was involved. I would have expected that a more experienced resident would result in lower cost. This may not have been demonstrated because the attending allowed the senior resident more latitude to continue a case even if the case took longer, whereas the attending would be more apt to intervene with a more junior resident if the case was not progressing. Attendings should be cognizant that the duration of ureteroscopic cases has a significant impact on cost and may wish to develop an algorithm based on time and or progression of the case whereby they may take over the case and have the resident assist.
Expensive disposable equipment, such as single-use ureteroscopes, was not used during this cost study analysis. I would anticipate higher costs would be associated with single-use vs reusable ureteroscopes.
The authors did demonstrate the benefit of having a dedicated scrub technician available. The presence of such an individual was a factor associated with cost reduction. This observation although obvious to ureteroscopists may not be apparent to cost-conscious operating room (OR) managers.