In-Hospital Costs Associated With an Expanded Endonasal Approach to Anterior Skull Base Tumors-Reference-Cited by-同舟云学术

In-Hospital Costs Associated With an Expanded Endonasal Approach to Anterior Skull Base Tumors

Published:2022-01-04 Issue:11 Volume:131 Page:1274-1280
ISSN:0003-4894
Container-title:Annals of Otology, Rhinology & Laryngology
language:en
Short-container-title:Ann Otol Rhinol Laryngol

Author:

Parasher Arjun K.¹²,Lerner David K.³^ORCID,Glicksman Jordan T.⁴⁵,Lin Theodore⁶^ORCID,Miranda Stephen P.⁷,Ebesutani Darren⁸,Kohanski Michael⁹,Lee John Y. K.⁷,Storm Phillip B.¹⁰,O’Malley Bert W.¹¹,Yosher Daniel⁷,Palmer James N.⁹,Grady Sean⁷,Adappa Nithin D.⁹

Affiliation:

1. Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL, USA

2. College of Public Health, University of South Florida, Tampa, FL, USA

3. Department of Otolaryngology—Head and Neck Surgery, Icahn School of Mount Sinai, New York City, NY, USA

4. Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

5. New England Ear Nose and Throat, Newton, MA, USA

6. Department of Otolaryngology—Head and Neck Surgery, Temple University, Philadelphia, PA, USA

7. Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA

8. Office of Clinical Research, University of Pennsylvania, Philadelphia, PA, USA

9. Department of Otorhinolaryngology—Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA

10. Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

11. Department of Otolaryngology—Head and Neck Surgery, University of Maryland, College Park, MD, USA

Abstract

Objective: To determine in-hospital costs associated with performing an EEA to anterior skull base pathology and to identify drivers of cost variability for patients undergoing endoscopic anterior skull base surgery. Methods: All endoscopic anterior skull base surgeries performed over a period from January 1st, 2015 to October 24th, 2017 were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and univariate analysis was performed using Stata software. Results: An EEA was associated with an average total in-hospital cost of $44 545. Compared to patients undergoing a transsphenoidal approach to pituitary tumor resection, EEA patients incurred higher in-hospital costs across all variables including a total cost increase of $15 921 (95% confidence interval $5720-26 122, P = .002). Univariate analysis of all endoscopic anterior skull base surgery patients showed a cost increase of $30 616 associated with post-operative cerebrospinal fluid (CSF) leak ($10 420-50 811, P = .004), $14 610 with post-operative diabetes insipidus (DI) ($4610-24 609, P = .004), and $11 522 with African-American patients relative to Caucasian patients ($3049-19 995, P = .008). Conclusions: Patients who undergo endoscopic EEA for resection of anterior skull base tumors typically incur greater in-hospital costs than patients undergoing a standard TSA. Post-operative complications such as CSF leak and DI, as well as ethnicity, are significant drivers of cost-variability.

Publisher

SAGE Publications

Subject

General Medicine,Otorhinolaryngology

Link

http://journals.sagepub.com/doi/pdf/10.1177/00034894211067583

Reference31 articles.

1. Health Care Spending in the United States and Other High-Income Countries

2. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

3. United States Health Care Reform

4. Health Care Employment Growth and the Future of US Cost Containment

5. Challenges in Understanding Differences in Health Care Spending Between the United States and Other High-Income Countries