Cost Comparison of Percutaneous Nephrolithotomy With and Without Intraoperative Cone-beam Computed Tomography: 18-month Postoperative Analysis.

Background and objective: Residual fragments (RFs) after percutaneous nephrolithotomy (PCNL) increase the risk of stone-related events (SREs) such as reinterventions and emergency department (ED) visits. Intraoperative cone-beam computed tomography (CBCT) facilitates detection and removal of RFs to improve stone-free rates and potentially reduce SREs. To determine whether the initial increase in surgical costs for CBCT in a hybrid operating room (OR) is offset by a reduction in overall expenses by minimizing SREs, we compared the total in-hospital health care costs of standard PCNL versus CBCT-PCNL over an 18-mo period. Methods: Data from a previous randomized controlled trial including 80 patients undergoing CBCT-PCNL and 80 undergoing conventional PCNL were analyzed. Procedural costs were calculated by multiplying operative duration by the Dutch reference price per minute, and adding disposable costs. Follow-up costs included costs for complications, SREs (reinterventions, ED visits, drainage, admissions), imaging, and consultations during 18 mo. Key findings and limitations: Assuming utilization rates of 42% for a hybrid OR and 92% for a conventional OR and following reference prices, we calculated mean total costs per patient of €8725 for the CBCT group and €8564 for the control group, with a difference of €167. The 40.2% higher procedural costs for hybrid-OR PCNL were nearly offset by 38.3% lower follow-up, complication, and SRE costs. Limitations include the single-center design, incomplete cost standardization, and the exclusion of non-hospital costs such as productivity loss. Conclusions and clinical implications: While PCNL with CBCT in a hybrid OR increases operative costs, it lowers SREs and unplanned care expenses. Even at a significantly lower hybrid OR utilization rate, total health care costs remain comparable, so PCNL-CBCT can facilitate predictable resource use and efficient care, with potential benefits for patients and health care systems. Patient summary: A new technique using CT (computed tomography) scans during surgery may help in more complete extraction of kidney stone fragments. Our study shows that even though this procedure is more expensive, it reduces the need for postoperative appointments, scans, emergency department visits and additional operations.