Synchronous Bilateral Percutaneous Nephrostolithotomy: Analysis of Clinical Outcomes, Cost and Surgeon Reimbursement

Purpose: We compared clinical outcomes, cost and physician reimbursement between simultaneous bilateral percutaneous nephrostolithotomy and theoretical matched staged bilateral percutaneous nephrostolithotomy. Materials and Methods: Between September 2005 and May 2007 we performed 200 percutaneous nephrostolithotomies including 17 synchronous bilateral procedures. Complete clinical and cost information was available and recorded for 15 patients. To compare variables between comparable synchronous and staged bilateral percutaneous nephrostolithotomy 152 unilateral percutaneous nephrostolithotomies were used to obtain similar parameters that were then used to estimate the outcomes of theoretical staged bilateral percutaneous nephrostolithotomy. Operative time, hospital length of stay, cost and physician reimbursement were determined according to CPT codes for stone complexity (50080 for stones less than 2 cm, 50081 for stones 2 cm or greater) to match case complexity per renal unit. Results: Mean patient age (±SD) in the synchronous bilateral percutaneous nephrostolithotomy group was 51 (±11) years and 25% of patients had staghorn calculi. The stone-free rate after the initial procedure was 27% (4 of 15) and second look nephroscopy was performed in 10 patients. Complications occurred in 4 patients and none required transfusion. Mean overall cost of synchronous bilateral percutaneous nephrostolithotomy was $10,129. Cumulative room time, length of stay and cost were higher in the staged than synchronous percutaneous nephrostolithotomies. Physician reimbursement was 11% to 46% less for synchronous bilateral percutaneous nephrostolithotomy. Conclusions: Synchronous bilateral percutaneous nephrostolithotomy benefits patients and third party payors by decreasing cumulative operating room time, length of stay and cost. However, there is a disincentive for surgeons, who are financially penalized for performing synchronous bilateral percutaneous nephrostolithotomy. Third party payors should consider revising putative reimbursement policies for synchronous bilateral percutaneous nephrostolithotomy as it is cost-effective in appropriate patients.