Evaluation of the real applicability of diagnosis-related groups for urinary tract lithiasis surgeries

Abstract

Introduction: Nephrolithiasis is a highly prevalent disease, being one of the most frequent urological conditions. Transureteroscopic Ureterolithotripsy (URL) and Percutaneous Nephrolithotomy (PCNL) are the main techniques used in the treatment of this disease. These two procedures have different levels of complexity, complications and costs of care. However, both are included in the same code of the DiagnosisRelated Groups (DRG). Objective: This study aims to investigate how these highly distinct procedures vary in terms of length of postoperative hospital stay and whether they should be coded in separate DRGs. Methods: The medical records of 893 patients who underwent URL or PCNL surgeries between September 2017 and February 2021 at a University Hospital were analyzed. The variables analyzed were gender, age, type of procedure, location and size of the stone, presence of previous comorbidities or urinary tract infection, length of hospital stay, and stone recurrence. Associations and comparisons between variables were assessed using the Chi-square and Mann-Whitney tests. Results: Despite being grouped in the same DRG codes, URL and PCNL have different means of hospitalization periods. Most patients who underwent URL were hospitalized for only one day and most patients who underwent PCNL were hospitalized for two days. Conclusion: This study demonstrates that URL average length of hospital stay was shorter than the hospitalization period recommended by the DRG for this procedure. Thus, a reassessment of the DRG codes is necessary and the creation of subdivisions in order to separate URL and PCNL into distinct codes is required.

Keywords

• nephrolithiasis
• nephrolithotomy
• percutaneous
• ureteroscopy
• diagnosis-related groups