<scp>Drivers</scp> of <scp>In‐Hospital</scp> Costs Following Endoscopic Transphenoidal Pituitary Surgery

Parasher, Arjun K.; Lerner, David; Glicksman, Jordan T.; Miranda, Stephen P.; Dimentberg, Ryan; Ebesutani, Darren; Kohanski, Michael A.; Lee, John Y.K.; Storm, Phillip B.; O’Malley, Bert W.; Palmer, James N.; Grady, M. Sean; Adappa, Nithin D.

doi:10.1002/lary.29041

Cited by 16 publications

(26 citation statements)

References 32 publications

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“…In contrast to previous studies, we did not find significant associations between costs and age ( 19 ), smoking status ( 14 , 47 ), comorbidities ( 23 , 28 , 47 ), MFI-5 score ( 51 ), Cushing’s disease ( 24 , 44 , 45 ) or readmissions ( 44 , 45 ). Age was not related to higher costs ( 19 ), which may be explained by the higher proportion of complex cases at younger age, compared to more patients with NFAs at higher age.…”

Section: Discussioncontrasting

confidence: 99%

“…Additionally, we identified factors associated with higher total costs, that are generally well explained by more complex patient and tumour characteristics, or a more complex clinical course ( Figure 3 ). So, increased costs were logically related to healthcare utilization (e.g., longer OR time, LOS, ICU), in concurrence with previous reports ( 5 , 14 – 16 , 24 , 28 , 44 – 50 ). Additionally, we found that patients with RCCs, dependent functional status, tumours invading the third ventricle, specific surgical approaches (i.e., combined transsphenoidal/transcranial, intradural, involvement of ENT-surgeon, nasoseptal flap skull base reconstruction) were increased costs.…”

Section: Discussionsupporting

confidence: 90%

“…This study evaluated the in-hospital direct costs (€16380) for the year after surgery, with higher mean costs in patients with RCCs (€23263) and craniopharyngiomas (€36129) compared to pituitary adenomas (€14462). In line with previous studies, total costs were mostly attributable to direct costs of the surgical procedure (55%) and to a lesser extent to hospitalization (28%), irradiation, and diagnostic investigations or consultations (17%) ( 14 , 42 , 43 ). Additionally, we identified factors associated with higher total costs, that are generally well explained by more complex patient and tumour characteristics, or a more complex clinical course ( Figure 3 ).…”

Section: Discussionsupporting

confidence: 89%

“…It is difficult to compare our outcomes to those of earlier studies, because of different healthcare systems and cost assessment methods. Economic evaluations for patients with pituitary tumours undergoing surgery have been mainly performed in the USA ( 12 – 16 , 42 – 45 , 48 ), reporting costs ranging from $20000 to $35000 ( 14 , 23 , 42 , 51 ). However, the USA has a different healthcare system than most European countries ( 52 ).…”

Section: Discussionmentioning

confidence: 99%

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Costs and Its Determinants in Pituitary Tumour Surgery

Dekkers

Vries²,

Najafabadi³

et al. 2022

Front. Endocrinol.

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PurposeValue-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients.MethodsWe retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs.Results271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke’s cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250).ConclusionsLength of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Costs and Its Determinants in Pituitary Tumour Surgery

Dekkers

Vries²,

Najafabadi³

et al. 2022

Front. Endocrinol.

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“…Postoperative CSF leakage is a frequent, serious, and costly complication resulting in a higher risk of meningitis and a longer hospital stay (43,44). The cause of this complication is either lack of recognition of a perioperative CSF leak or an incomplete closure of the leak, but small perioperative CSF leaks are not always noticeable without enhanced visualization (45).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients

et al. 2021

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BackgroundThe endoscopic endonasal transsphenoidal approach (EETA) is an established technique for the resection of a large variety of benign sellar and suprasellar lesions, mostly pituitary adenomas. It has clear advantages over the microscopic approach, like a superior close-up view of the relevant anatomy and the tumor-gland interface, an enlarged working angle, as well as an increased panoramic vision inside the surgical area. We have been performing the EETA for over a decade, and this study will focus on perioperative and postoperative outcomes and complications and their association with the learning curve.Material and MethodsAll patients in our tertiary referral center (n = 369) undergoing an EETA for a lesion of the sellar and suprasellar region between January 1st 2008 and December 31st 2018 were included, and data were retrospectively retrieved from the electronic patient records.ResultsMedian follow-up after surgery was 55 months. Pituitary adenomas (n = 322) were the most frequent pathology. Headache (43.4%) and loss of vision (29.3%) were the most common presenting symptoms. Median procedure duration was significantly longer during the initial 5 years (106 versus 79 minutes; p <0.0001), but incidence of peri- and postoperative CSF leaks in the early years was not significantly higher. Knosp grade >2 was associated with perioperative CSF leak (p =0.002), and perioperative CSF leak was associated with postoperative CSF leak (p <0.001). Almost all cases of meningitis were preceded by a postoperative CSF leak. In 22.4% of patients, tumor recurrence required additional therapy. Perioperative (iatrogenic) mortality was 0.8%. The overall hospital stay decreased over time from an average of 7 to 5 days, and the case load increased yearly (p =0.015).ConclusionThe EETA is an excellent technique with complication rates comparable to or even lower than those in large microsurgical series in the literature. EETA has a significant learning curve affecting the procedure duration. Throughout the first 10 years following the transition from the microscopic approach to the EETA in our cohort, the caseload increased and hospital stay was reduced, while no increase in peri- and postoperative complications was observed.

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In‐Hospital Costs for Open versus Endoscopic Endonasal Approach for Craniopharyngioma Resection

et al. 2022

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Objective: To determine the in-hospital cost implications of an expanded endoscopic endonasal approach (EEEA) for craniopharyngioma resection relative to the traditional open transcranial approach.Methods: All craniopharyngioma surgeries performed at a single institution over a period from January 1st 2001 to October 31th 2017 were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and univariate regression analysis was performed using R software.Results: Thirty-six patients met study criteria, including 22 undergoing an open approach and 14 undergoing an EEEA. There was a significantly longer average length of stay among patients undergoing open resection (21.5 vs. 10.6 days, p = 0.024). The average total in-hospital cost of a patient undergoing an EEEA was $58979.3 compared to $89142.3 for an open approach (p = 0.127). On univariate regression analysis, the total in-hospital cost for a patient undergoing an open approach relative to an EEEA was $30163.0 (p = 0.127). The open approach was exclusively performed from study onset until April 2010 (16 patients). From April 2010 to August 2013, 6 open approaches and 5 EEEA were performed. The EEEA has been exclusively performed from August 2013 until the conclusion of our study period (9 patients).Conclusions: There has been a shift toward surgical resection of craniopharyngioma via an EEEA approach for amenable tumors. Our study demonstrates that the EEEA has become the preferred surgical approach at our institution, and shows that the EEEA is associated with shorter postoperative length of stay and lower total in-hospital cost.

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Drivers of In‐Hospital Costs Following Endoscopic Transphenoidal Pituitary Surgery

Cited by 16 publications

References 32 publications

Costs and Its Determinants in Pituitary Tumour Surgery

Costs and Its Determinants in Pituitary Tumour Surgery

Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients

In‐Hospital Costs for Open versus Endoscopic Endonasal Approach for Craniopharyngioma Resection

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