What Are In-Hospital Cost Drivers of Endoscopic Transphenoidal Pituitary Surgery?

What are the patient and clinical factors that determine variability in hospital costs following endoscopic transphenoidal pituitary surgery?

BOTTOM LINE

Postoperative cerebrospinal fluid (CSF) leak, current smoking status, and non-Caucasian ethnicity are associated with significantly increased costs following endoscopic transphenoidal pituitary surgery, and understanding of such cost drivers is critical for future cost control and value creation initiatives.

BACKGROUND: The shift toward value-based medical care and bundled payments for reimbursement purposes underscores a need to understand drivers of costs and variation for procedures. Endoscopic transphenoidal pituitary surgery is a common skull base operation that is usually associated with significant cost variability. The patient and clinical factors that drive in-patient hospital costs following this procedure are not well understood.

STUDY DESIGN: Retrospective single-institution study.

SETTING: University of Pennsylvania, Philadelphia, Penn.

SYNOPSIS: Researchers reviewed records for all endoscopic transphenoidal pituitary surgeries performed in a single institution from Jan. 1, 2015, to Oct. 24, 2018, gathering data on patient factors, tumor characteristics, and cost variables during each hospital stay. They identified six cost variables (direct and indirect). A total of 190 patients (96 males, 94 females, average age 52.8 years) were included in the analysis. Results showed the average total in-hospital cost for a patient receiving endoscopic transphenoidal pituitary surgery as $38,447. Postoperative CSF leak was associated with significantly increased costs across all variables, more than doubling the cost of the hospital stay after surgery. Current smoking status among study participant records was associated with a cost difference of $20,189, suggesting that preoperative counseling for smoking cessation may be valuable from clinical and cost-saving perspectives. Non-Caucasian ethnicity was associated with a significant total cost increase, which authors noted is likely multifactorial and reflective of broader socioeconomic disparities. They stated that this study’s identification of patient and clinical characteristics that drive post-endoscopic transphenoidal pituitary surgery costs may facilitate future cost control and value creation initiatives. Study limitations included its retrospective and single-institution nature, relatively small sample size, and lack of bed assignment data that might have provided further insight.

CITATION: Parasher AK, Lerner DK, Glicksman JT, et al. Drivers of in-hospital costs following endoscopic transphenoidal pituitary surgery. Laryngoscope. 2021;131:760-764.