UP-172 Cost analysis and feasibility of a minimally invasive, in-office hydrocelectomy
Thursday June 27, 2019 from

Andrew A. Di Pierdomenico, Canada

Urology Fellow

University of Toronto, Division of Urology

University of Toronto


Cost analysis and feasibility of a minimally invasive, in-office hydrocelectomy

Andrew A. Di Pierdomenico1, Jeffrey Law1, Alp Sener1, Jeffrey D. Campbell1.

1Department of Surgery, Division of Urology, Western University, London, ON, Canada

Introduction: Procedures performed in the operating room (OR) have considerable costs associated with labour, materials and facility expenditures. We sought to assess the safety and efficacy of our experience with an in-office hydrocelectomy and explore the cost-savings at our institution. 

Methods: We prospectively collected data evaluating our experience with a “minimal-incision modified fenestration” hydrocelectomy under local anaesthetic. Principles of this technique include: i) ipsilateral spermatic cord block ii) 2cm transverse scrotal incision and hydrocele drainage iii) mobilization then excision of the redundant tunica vaginalis iv) oversewing of the resection margins for hemostasis. We report on our complications and recurrence rate. An exploration into potential cost-savings was performed with data provided by the Department for Quality Measurement and Clinical Decision Support at St. Joseph’s Hospital utilizing cost data for hydrocelectomy cases performed in the operating room during the 2018-2019 fiscal year. 

Results: Eight in-office hydrocelectomies were performed in 7 patients (mean age: 52.5yrs; range: 20-81yrs). There were no recurrences or complications observed over a mean follow-up of 9.2 mos (range: 3-12 mos). Hydrocelectomy performed in the OR had an average estimated cost of $2223/procedure. The largest component of this cost was labour at $744/procedure of which the post-anesthetic care unit ($301), OR ($220) and day surgery units ($157) were the largest constituents. The labour cost of an in-office hydrocelectomy ranges between $34-49/procedure which yields a labour savings of at least $695/procedure. Reduced materials, medications, cleaning and maintenance further improve cost savings to more than $1000/procedure.

Conclusion: In-office hydrocelectomy is safe and not associated with an increased risk of complications in our small cohort. Performing hydrocelectomies in an ambulatory setting may provide substantial cost savings to the hospital.

Lectures by Andrew A. Di Pierdomenico

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