Single Incision Midurethral Sling Site of Care: Office-based Ambulatory Surgical Unit versus Hosptial-based Ambulatory Surgical Unit Setting

Abstract

Study objective: To compare the economic difference in terms of overall costs between two Ambulatory Surgical Unit (ASU) settings in which a midurethral single incision sling (MSIS) can be performed.

Design: A retrospective cohort study was carried out, examining the implanting of an MSIS performed at two different ASU settings by a single surgeon. Total cost was determined by assessing differences in charges and subsequent reimbursement associated with the procedure at each ASU setting. Time was measured using an EMR system for tracking both patient entry/exit from the facility as well as intraoperative time. Adverse events commonly associated with the procedure and patient-reported unanticipated adverse events were collected. A validated Surgical Satisfaction Questionnaire was administered postoperatively.

Setting: University Health Network Teaching Hospital.

Patients: A total of 125 women with stress urinary incontinence.

Intervention: MSIS.

Measurement and main results: Between January 2016 until August 2020, 125 women underwent an MSIS procedure. The total office-based ASU (O-ASU) charges averaged $4564.00 (reimbursement of $2642.07). The total hospital-based ASU (H-ASU) charges averaged $40 136 (reimbursement of $9000), as well as an anesthesia average charge of $800 (reimbursement of $500). The average O-ASU total patient encounter time was 53.76 minutes versus 344.702 minutes for the H-ASU. There was no difference between commonly associated or unanticipated adverse events nor global patient satisfaction.

Conclusions: Based on overall cost, total encounter time, and global patient satisfaction, a certified O-ASU is an optimal site of care for MSIS for surgical management of female stress urinary incontinence.

Keywords: Ambulatory Surgical Unit; Mid-Urethral Single Incision Sling; Patient Satisfaction; Reimbursement; Stress urinary incontinence.