<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 17 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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Time is money: An analysis of cost drivers in ambulatory sinus surgery

Lerner,

Phung,

Workman

et al. 2024

Int Forum Allergy Rhinol

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BackgroundFunctional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability.MethodsWe performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed.ResultsA total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n = 99) of nasal polyps and 31.2% (n = 69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p = 0.04), in addition to presence of nasal polyps ($531.96, p = 0.04). There was no significant association between total costs and the remaining clinical and demographic factors.ConclusionsCosts associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost‐related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence‐based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.

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Drivers of In‐Hospital Costs Following Endoscopic Transphenoidal Pituitary Surgery

Cited by 17 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

Time is money: An analysis of cost drivers in ambulatory sinus surgery

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