Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis.

Abstract

Iatrogenic ureteral injury during gynaecological surgery is associated with increased morbidity when not diagnosed during the initial surgery. Preoperative insertion of ureteral catheters may enhance intraoperative recognition of injury and repair, but it is controversial. We sought to analyse the costs of this approach. DESIGN/SETTING/POPULATION: A decision-tree analysis of clinical scenarios of using universal ureteral catheterisation compared with no catheterisation was conducted for benign abdominal hysterectomy and radical hysterectomy. Diagnostic-Related Groups and Current Procedural Terminology coding and reimbursement information were used as calculated for Medicare patients in the USA. Differences in projections of total hospital-related costs related to clinical scenarios of perioperative care for women undergoing hysterectomy with or without ureteral catheterisation. Universal ureteral catheterisation is cost saving when the rate of ureteral injury during benign abdominal hysterectomy or radical hysterectomy is greater than 3.2%. The cost savings of universal ureteral catheterisation at hysterectomy depend on the injury rate but are minimal at common levels of injury.