Long-term economic outcomes of ureteral injury in the United States
Creators: name: McCarus, Steven D.
name: Shortridge, Emily F.
name: Kimura, Tomomi
name: Feng, Qi
name: Han, Wei
name: Jiang, Baoguo
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Medicine
subject: Cell Biology
subject: Sociology
subject: FOS: Sociology
subject: Developmental Biology
subject: Cancer
subject: Science Policy

description: Ureteral injuries (UIs) during surgical procedures can have serious consequences for patients. Although UIs can result in substantial clinical burden, few studies report the impact of these injuries on payer reimbursement and patient cost-sharing. This retrospective study evaluated 30-day, 90-day, and 1-year healthcare resource utilization for patients with UIs and estimated patient and payer costs. Patients aged ≥ 12 years who underwent abdominopelvic surgery from January 2016 to December 2018 were identified in a United States claims database. Patients were followed for 1 year to estimate all-cause healthcare visits and costs for patients and payers. Surgeries resulting in UIs within 30 days from the surgery date were matched to surgeries without UIs to estimate UI-attributable visits and costs. Five hundred twenty-two patients with UIs were included. Almost a third (29.9%) of patients with UIs had outpatient surgery. Patients with UIs had slightly more healthcare visits, and a 15.3% higher 30-day hospital readmission rate than patients without UIs. Patient costs due to UIs were not statistically significant, but annual payer costs attributable to UIs were $38,859 [95% CI: 28,142–49,576], largely driven by inpatient costs. UIs add substantial cost for payers and result in more healthcare visits for patients. These findings highlight the importance of including inpatient and outpatient settings for UI prevention. Although UIs are rare, the associated patient and payer burdens are high; thus, protocols or techniques are needed to recognize and avert UIs, as current guideline recommendations are lacking. Though not common, injuries to the ureters, which carry urine from the kidneys to the bladder, can occur during surgeries on the abdomen. Ureter injuries can lead to discomfort, pain, infection, and death. Patients with ureter injuries can also require additional care from doctors, leading to increased costs for both patients and insurance companies. The researchers in this study calculated the costs of ureter injuries at 30-days, 90-days, and 1-year after surgery using anonymous information from insurance claims from patients who received abdominal surgery. Compared to patients who did not have a ureter injury from surgery, a higher percentage of those with ureter injuries had healthcare visits in the year following surgery and a greater chance of being readmitted to the hospital in the 30 days after surgery. Costs for both patients and insurance companies increased in the year after surgery. Insurance companies paid almost $39,000 more on average per patient with ureter injury in the year after surgery, compared to costs for patients who did not have ureter injuries. Patients with ureter injuries paid approximately $1,000 more out-of-pocket in the year after surgery compared to patients without ureter injuries. This study showed that ureter injuries increased costs for both patients and insurance companies. Patients with ureter injuries needed more healthcare, while the insurance companies for those patients had higher financial costs. Though ureter injuries are uncommon, this study supports efforts to minimize their occurrence to prevent these impacts on patients and the healthcare system.