Financial analysis of laparoscopic versus open nephrectomy in the pediatric age group

The authors compared the cost of laparoscopic nephrectomy to open nephrectomy in the pediatric age group. One hundred seventeen consecutive laparoscopic nephrectomies performed by a surgeon with extensive experience with this approach between April 2003 and August 2006 were included. A control group of 24 consecutive open nephrectomies performed by urologists who do not use the laparoscopic approach were also included. Inclusion criteria for surgery were a poor or nonfunctioning kidney related to severe obstructive or refluxing nephropathy and a multicystic dysplastic kidney. The length of operation, length of stay, and disposable equipment used were recorded and the different approaches were compared statistically with an unpaired t test. The mean ( standard deviation [SD]) duration of the procedure was 79 minutes (32) in the laparoscopic group and 85 minutes (35) in the control group (P = 0.41). The mean (SD) cost of the disposable instruments used during the operation was 274 pound ( 160) in the laparoscopic group and 20 pound ( 5) in the control group (P = 0.0001). The mean ( SD) hospital stay was 1 night (0.43) with a mean (SD) cost of 677 pound ( 291) in the laparoscopic group, and 3 nights ( 2) with a mean (SD) cost of 2031 pound (1354) in the control group (P = 0.0001). The mean ( SD) total cost of the procedure was 951 pound ( 451) for the laparoscopic group and 2051 pound (1359) for the open one (P = 0.0001). In our experience, the laparoscopic approach in the pediatric age group is 54% less expensive than the open approach.