Pharmacoeconomical Consequences of Postoperative CSF Leaks After Intracranial Surgery – A Prospective Analysis

Abstract

Cerebrospinal fluid (CSF) leaks are well-known and frequent complications of intracranial procedures with their clinical aspects covered by numerous studies. Little, however, is known about the pharmacoeconomical aspects of this specific complication. 545 patients with a variety of intracranial procedures (elective and trauma) were recruited for a multicenter, prospective, observational study over a 13-month period. A specific pharmacoeconomic analysis was performed in 168 of these patients from the institution of the first author covering all clinical and pharmaco-economical aspects of this specific complication. Of all patients, 5.36% developed a postoperative CSF leak. Treatment of the leak required numerous diagnostic and therapeutic procedures such as reoperations (n = 6), lumbar punctures (n = 11) or lumbar drainages (n = 4). Costs for these procedures and prolonged hospital stays nearly doubled the costs per case (€14079/case without a fistula vs. €25499/case with a fistula). Reimbursement for the hospital covered these extra costs, but net earnings per case were diminished by €565 in cases with a CSF leak. The authors conclude that the presence of a CSF leak after an intracranial operation - although not influencing outcome in general - results in additional diagnostic and therapeutic procedures for the patient, an enormous increase in costs for the community, and a financial loss for the hospital. Strategies to lower this complication rate should therefore urgently be developed both from a clinical and a pharmacoeconomical point of view.

Predictive Factors, 30-Day Clinical Outcomes, and Costs Associated with Cerebrospinal Fluid Leak in Pituitary Adenoma Resection

“…The incidence of CSF leak in our study population of 3.9% was comparable to previous studies examining CSF leak following transsphenoidal surgery. 7,19 Of the 20 preoperative variables studied between groups (CSF leak vs. nonleak), none were significantly more common in the CSF leak group (►Table 1). This is in contrast to some previous studies.…”

“…[4][5][6] Piek et al in Germany found a 5.36% leak rate in their 168 patients, whereas Grotenhuis in the Netherlands found a 10.7% rate in 412 patients. 7,8 As discussed by Lobatto et al identifying patients with risk factors for complications like CSF leak is imperative for appropriate consideration of preoperative planning and timing of the operation, patient counseling, consultation or referral to a center of excellence, alternative treatments, and postoperative management such as short versus long stay. 9 Some literature has identified risk factors for postoperative CSF leak.…”

“…The costs were increased in CSF leaks-€25,286.60/case with a reimbursement of €25,499.39 (net þ€210 per case). 7 It is not surprising that a complication like CSF leak leads to higher costs. To help alleviate this increased cost, it is helpful to identify the drivers of this cost so providers and administrators can help mitigate the financial burden.…”

Liquorrhea after removal of fourth ventricle tumors in children. Retrospective analysis of a series of 211 primary surgeries

“…Проблема послеоперационной ликвореи до сих пор остается актуальной, поскольку данное осложнение приводит к дополнительным страданиям пациентов и удваивает затраты на лечение [1,10]. В детской нейрохирургической практике к пациентам с повышенным риском послеоперационной ликвореи традиционно относят все операции на ЗЧЯ [4,11,12].…”

“…Исследования в этом направлении необходимо продолжать, учитывая потенциально предотвратимый характер проблемы и ее значение в общем результате лечения нейроонкологических пациентов. Учитывая социоэкономическую составляющую данной проблемы, затраты на поиск эффективных средств быстро окупятся [1,10].…”