Prone vs Supine PCNL: What about the Cost?

Abstract

Introduction & Objectives: Prone position has been the standard for PCNL in years, whereas the supine position has recently started to gain popularity. The study for surgical outcomes still vary and study for cost-effectiveness are still lacking. We aimed to compare the surgical outcomes and cost effectiveness of prone versus supine PCNL in our institution. Material & Methods: This study was done retrospectively by analyzing medical records on 51 patients underwent PCNL in Saiful Anwar General Hospital Malang from January 2016 until October 2017. The outcomes of stone free rate, body mass index (BMI), stone size, operative time, anaesthetic time, length of stay (LOS) in hospital and complications were compared. For Cost Effectiveness Study, total cost, anesthesia and disposable equipment was recorded. Results and Discussion: There was no significant difference in both groups characteristics. The supine group had lower blood loss (0.54 mg/dl vs 1.37 mg/dl, p=0.001), shorter mean operative time (57 minutes vs 78 minutes, p=0.001), shorter mean anesthetic time (71 minutes vs 107 minutes, p<0.001). Supine group was associated with significantly cheaper disposable equipment used for surgery (4,985,636 IDR in prone vs 4,229,770 IDR in supine (p<0.001)) and anesthesia (353,454 IDR in prone vs 105,120 IDR in supine (p<0.001)), and cheaper total cost (17,623,363 IDR in prone vs 15,175,305 in supine (p = 0.038)). Conclusion: In our study, supine position has lower blood loss, shorter operative and anaestethic time. The supine PCNL is also more cost-effective in our institution compared to prone PCNL. We suggest that the PCNL in the supine position is a promising alternative.