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Is it cost effective to allow urological trainees to perform laparoscopic nephrectomy?

Is it cost effective to allow urological trainees to perform laparoscopic nephrectomy?. Michael Kimuli , Thomas Spurgeon and Jon Cartledge. St James’ University Hospital, Leeds.

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Is it cost effective to allow urological trainees to perform laparoscopic nephrectomy?

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  1. Is it cost effective to allow urological trainees to perform laparoscopic nephrectomy? Michael Kimuli, Thomas Spurgeon and Jon Cartledge. St James’ University Hospital, Leeds “To consider dear to me as my parents him who taught me this art, to look upon his children as my own brothers; and to teach them this art if they so desire”….(Hippocrates).

  2. Introduction • “Poor productivity threatens Britain’s long term economic growth and competitiveness ”. George Osborne • The operating theatre is one of the most expensive areas in the NHS. As such, it continues to be an area of focus to improve efficiency and decrease costs. • Hypothesis: Is there an unsustainable increase in cost in the current economic climate when a trainee rather than an experienced surgeon performs laparoscopic nephrectomy.

  3. Methods A prospective collection of data of all lap nephrectomies performed by a single surgeon or his mentored trainee were reviewed. We analysed ancillary costs, including theatre time, length of hospital stay and transfusion rates. Cost analysis was undertaken based on opportunity cost which is defined as the “cost” used to quantify the value difference between investing in one product or activity vs another. Results

  4. Conclusions • Based on increased operative times, transfusion rates and length of hospital stay, each case cost, on average, an extra £814. • Over the 8-year period, the increased cost to the trust was £34,180. • While an extra “ small case” could be done, trainees save their hospitals/consultants extra costs by performing other service duties. • Furthermore during this 8-year period, at least 8 individuals were trained to independent practice in lap nephrectomies at a cost of only £4270 per individual. • In conclusion, therefore, we think that the modest impact on hospital economics of allowing SpRs to perform lap nephrectomy represents sound economic value.

  5. “Skill to do comes of doing”. Ralph Waldo Emerson

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