Costs and Perioperative Outcomes Associated with Open versus Endoscopic Resection of Sinonasal Malignancies with Skull Base Involvement

Abstract

Objective To compare financial and perioperative outcomes between endoscopic and open surgical approaches in the surgical management of sinonasal malignancies. Design Retrospective chart review. Setting Tertiary care hospital. Participants Patients undergoing surgical resection of a sinonasal malignancy from January 2000 to December 2014. Main Outcome Measures In-hospital costs, complications, and length of stay (LOS). Results Of 106 patients, 91 received open surgery (19 free flap and 72 non-free flap) and 15 were treated with purely endoscopic approaches. Free flaps had a significantly higher average cost, operative time, and LOS compared to both non-free flap (p < 0.001, < 0.001, and < 0.01) and endoscopic (p = 0.01, 0.04, and < 0.01) groups. There were no significant differences in average costs between endoscopic and non-free flap groups ($19,157 vs. $14,806, p = 0.20) or LOS (5.7 vs. 6.4 days, p = 0.72). Compared with the non-free flap group, the endoscopic group had a longer average operative time (8.3 vs. 5.5 hours, p < 0.01) and higher rates of cerebrospinal fluid (CSF) leak (13 vs. 0%, p = 0.01) and intensive care unit (ICU) admission (80 vs. 36%, p < 0.01). Surgical approach (open vs. endoscopic) was not a significant predictor of any financial or perioperative outcome on multivariable analysis. Conclusion Hospital costs are comparable between endoscopic and open approaches when no free tissue reconstruction is required. Longer operative times, higher CSF leak rates, and our institutional protocol necessitating ICU admission for endoscopic cases may account for the failure to demonstrate cost savings with endoscopic surgery.