Endoscopic vs. Microscopic Resection of Sellar Lesions—A Matched Analysis of Clinical and Socioeconomic Outcomes

Abstract

BackgroundDirect comparisons of microscopic and endoscopic resection of sellar lesions are scarce, with conflicting reports of cost and clinical outcome advantages.ObjectiveTo determine if the proposed benefits of endoscopic resection are realized on a population level.MethodsWe performed a matched cohort study of 9,670 adult patients in the MarketScan database who underwent either endoscopic or microscopic surgery for sellar lesions. Coarsened matching was applied to estimate the effects of surgical approach on complication rates, length of stay (LOS), costs, and likelihood of postoperative radiation.ResultsWe found that LOS, readmission, and revision rates did not differ significantly between approaches. The overall complication rate was higher for endoscopy (47% compared to 39%, OR 1.37, 95% CI 1.22–1.53). Endoscopic approach was associated with greater risk of neurological complications (OR 1.32, 95% CI 1.11–1.55), diabetes insipidus (OR 1.65, 95% CI 1.37–2.00), and cerebrospinal fluid rhinorrhea (OR 1.83, 95% CI 1.07–3.13) compared to the microscopic approach. Although the total index payment was higher for patients receiving endoscopic resection ($32,959 compared to $29,977 for microscopic resection), there was no difference in long-term payments. Endoscopic surgery was associated with decreased likelihood of receiving post-resection stereotactic radiosurgery (OR 0.67, 95% CI 0.49–0.90) and intensity-modulated radiation therapy (OR 0.78, 95% CI 0.65–0.93).ConclusionOur results suggest that the transition from a microscopic to endoscopic approach to sellar lesions must be subject to careful evaluation. Although there are evident advantages to transsphenoidal endoscopy, our analysis suggests that the benefits of the endoscopic approach are yet to be materialized.

Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain

“…Additionally, nonsurgical and surgical cohorts were matched for age groups, sex, and comorbidities with coarsened exact matching, a method that is similar to propensity score matching but reduces model dependence and estimation error. 22,23 All tests were 2-sided and conducted at the .05 level of significance. All analyses were performed with SAS statistical software version 9.4 (SAS Institute Inc) and Stata statistical software version 14 (StataCorp LLC).…”

ICAR: endoscopic skull‐base surgery

“…In contrast to the above data, several authors have performed level 4 studies that report less favorable cost scenarios for EEAs . Azad et al .…”

“…In contrast to the above data, several authors have performed level 4 studies that report less favorable cost scenarios for EEAs . Azad et al . completed a level 4 retrospective, observational administrative database study that reported the total index payment was higher for EEA ($32,959) vs microscopic approach ($29,977) and that EEA benefits were not seen at population level.…”

“…completed a level 4 retrospective, observational administrative database study that reported the total index payment was higher for EEA ($32,959) vs microscopic approach ($29,977) and that EEA benefits were not seen at population level. However, no ICERs or sensitivity analyses were carried out . Little et al .…”

“…Analogous to the early applications of the endoscope used to approach the skull base, the vast majority of the current cost data report those associated with transsphenoidal sellar approaches, primarily between the use of microscopic and endoscopic techniques . Other studies have examined costs associated with endoscopic endonasal resection of meningiomas, sinonasal malignancies, as well as intra‐arachnoidal pathology .…”