Incidence, Healthcare Resource Utilization, and Costs Associated with Intraoperative Ureteral Injuries: Evidence from a German Claims Database.

INTRODUCTION: Intraoperative ureteral injury (IUI) is a serious complication that can result in substantial clinical and economic burdens. This retrospective study evaluated incidence, healthcare resource utilization (HRU), and associated costs among patients with and without IUIs in Germany. METHODS: This descriptive, comparative, longitudinal study included anonymized claims data from the German WIG2 Benchmark Database. Patients aged ≥ 18 years who underwent abdominopelvic surgery with a risk of IUI from 1 January 2014 to 31 December 2021 were included. IUI incidence proportions were calculated overall and by surgery type (gastrointestinal [GI], gynecological [GYN], and other abdominopelvic surgeries). HRU associated with inpatient stays for index hospitalizations and all-cause costs were summarized during the 1-year follow-up. RESULTS: Among 159, 581 patients, 217 had IUIs, with an overall incidence proportion of 0.14%. GI procedures accounted for 43.8% of IUIs (incidence proportion 0.10%), GYN for 42.4% (0.16%), and other abdominopelvic procedures for 13.8% (0.28%). Proctectomy (1.03%) and hysterectomy with removal of other structures (0.74%) had the highest IUI incidence proportions. Patients with IUIs had significantly longer mean inpatient stays vs. those without IUIs (19.1 vs. 9.4 days; mean difference 9.6 days; P < 0.001). During the 1-year follow-up, patients with IUIs incurred substantially higher total healthcare costs vs. patients without IUIs (mean €67,041 vs. €38,177; mean difference €28,864; P = 0.001). More patients with IUIs experienced postsurgical inpatient admissions (81.5% vs. 41.2%; P < 0.001) and emergency visits (39.8% vs. 20.8%; P < 0.001) vs. those without IUIs. The increased costs were mainly due to inpatient hospital stays (mean €26,046 vs. €13,600 for patients with vs. without IUIs, respectively; mean difference €12,445; P < 0.001). CONCLUSIONS: Although relatively rare, patients who experienced IUIs had significantly higher HRU and costs vs. patients without IUIs. Targeted strategies are crucial for reducing IUIs and improving clinical and economic outcomes among at-risk patients.