Hospital charges following simultaneous kidney-pancreas transplantation: enteric drainage versus bladder drainage

Background. Enteric drainage (ED) is associated with reduced morbidity comp ared with bladder drainage (BD) after simultaneous kidney-pancreas transpla ntation (SKPT) and is becoming increasingly common (more than 50% of SKPTs done in the US in 1998 were performed with enteric drainage). Although seve ral studies have reported the morbidity and graft survival of ED compared w ith BD previously, there are limited data available comparing the length of stay and hospital charges between these two drainage procedures. Methods. Fourteen SKPTs were performed during the period January 1995-May 1 998 using BD and 20 during June 1998-August 1999 using ED. Hospital charges analyzed included the following categories: pharmacy, inpatient room, labo ratory, operating room, medical-surgical supply, radiology/nuclear medicine , and miscellaneous. Organ acquisition charges and professional fees were n ot included in this analysis. Results. The mean hospital stay for patients with ED was 7.8 +/- 2.2 d (ran ge 5-12 d; median 7.5 d) compared with 15.9 +/- 7 d (range 8-38 d; median 1 5 d) for patients with BD (p = 0.002). The mean hospital charges during ini tial hospitalization for the ED group were $36 582 +/- 11 424 compared with $64 555 +/- 29 054 for the BD group (p = 0.005). There was a significant d ecrease in the charges relating to pharmacy, inpatient room, laboratory, ra diology/nuclear medicine, and miscellaneous category in the ED group compar ed with the BD group, while the charges relating to operating room and medi cal-surgical supply were no different between the two groups. One-year actu arial kidney and pancreas graft survival rates were 83% and 93%, respective ly, for the BD group and 90% and 80%, respectively, for the ED group (p = N S). Conclusions. SKPT patients with ED had a 43% reduction in hospital charges and equivalent pancreas and kidney graft survival rates compared with SKPT patients with BD. A shorter hospital stay and a reduction in pharmacy, radi ology/nuclear medicine, and laboratory charges contributed to the decreased hospital charges in SKPT patients with ED.