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Comparative inpatient resource utilization for patients undergoing endoscopic or microscopic transsphenoidal surgery for pituitary lesions.
- Source :
-
Journal of neurosurgery [J Neurosurg] 2014 Jul; Vol. 121 (1), pp. 84-90. Date of Electronic Publication: 2014 Apr 11. - Publication Year :
- 2014
-
Abstract
- Unlabelled: OBJECT.: An increasingly important measure in the health care field is utilization of hospital resources, particularly in the context of emerging surgical techniques. Despite the recent widespread adoption of the endoscopic transsphenoidal approach for pituitary lesion surgery, the health care resources utilized with this approach have not been compared with those utilized with the traditional microscopic approach. The purpose of this study was to determine the drivers of resource utilization by comparing hospital charges for patients with pituitary tumors who had undergone either endoscopic or microscopic transsphenoidal surgery.<br />Methods: A complete accounting of all hospital charges for 166 patients prospectively enrolled in a surgical quality-of-life study at a single pituitary center during October 2011-June 2013 was undertaken. Patients were assigned to surgical technique group according to surgeon preference and then managed according to a standard postoperative institutional set of orders. Individual line-item charges were assigned to categories (such as pharmacy, imaging, surgical, laboratory, room, pathology, and recovery unit), and univariate and multivariate statistical analyses were conducted.<br />Results: Of the 166 patients, 99 underwent microscopic surgery and 67 underwent endoscopic surgery. Baseline demographic descriptors and tumor characteristics did not differ significantly. Mean total hospital charges were $74,703 ± $15,142 and $72,311 ± $16,576 for microscopic and endoscopic surgery patients, respectively (p = 0.33). Furthermore, other than for pathology, charge categories did not differ significantly between groups. A 2-step multivariate regression model revealed that length of stay was the most influential variable, followed by a diagnosis of Cushing's disease, and then by endoscopic surgical technique. The model accounts for 42% of the variance in hospital charges.<br />Conclusions: Study findings suggest that adoption of the endoscopic transsphenoidal technique for pituitary lesions does not adversely affect utilization of resources for inpatients. The primary drivers of hospital charges, in order of importance, were length of stay, a diagnosis of Cushing's disease, and, to a lesser extent, use of the endoscopic technique. This study also highlights the influence of individual surgeon practice patterns on resource utilization.
- Subjects :
- Adenoma economics
Adenoma pathology
Adult
Aged
Female
Health Resources economics
Hospital Charges
Humans
Length of Stay
Male
Middle Aged
Neurosurgical Procedures methods
Pituitary Gland pathology
Pituitary Neoplasms economics
Pituitary Neoplasms pathology
Treatment Outcome
Adenoma surgery
Health Resources statistics & numerical data
Inpatients
Neurosurgical Procedures economics
Pituitary Gland surgery
Pituitary Neoplasms surgery
Sphenoid Bone surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1933-0693
- Volume :
- 121
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 24724857
- Full Text :
- https://doi.org/10.3171/2014.2.JNS132095