Original Report

Drivers of In-Hospital Costs Following Endoscopic Transphenoidal Pituitary Surgery

Corresponding Author

Arjun K. Parasher MD

[email protected]

Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.

College of Public Health, University of South Florida, Tampa, Florida, U.S.A.

Send correspondence to Arjun K. Parasher, MD, 12901 Bruce B Downs Blvd, MDC73, Tampa, FL 33612. E-mail: [email protected]

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David K. Lerner MD,

David K. Lerner MD

orcid.org/0000-0002-0431-2920

Department of Otolaryngology–Head and Neck Surgery, Icahn School of Mount Sinai, New York City, New York, U.S.A.

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Jordan T. Glicksman MD, MPH,

Jordan T. Glicksman MD, MPH

orcid.org/0000-0002-9076-6557

Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.

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Stephen P. Miranda MD,

Stephen P. Miranda MD

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Ryan Dimentberg BS,

Ryan Dimentberg BS

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Darren Ebesutani BA,

Darren Ebesutani BA

Office of Clinical Research, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Michael Kohanski MD, PhD,

Michael Kohanski MD, PhD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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John Y. K. Lee MD, MSCE,

John Y. K. Lee MD, MSCE

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Phillip B. Storm MD,

Phillip B. Storm MD

Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.

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Bert W. O'Malley Jr. MD,

Bert W. O'Malley Jr. MD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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James N. Palmer MD,

James N. Palmer MD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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M. Sean Grady MD,

M. Sean Grady MD

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Nithin D. Adappa MD,

Nithin D. Adappa MD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Arjun K. Parasher MD,

Corresponding Author

Arjun K. Parasher MD

[email protected]

Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.

College of Public Health, University of South Florida, Tampa, Florida, U.S.A.

Send correspondence to Arjun K. Parasher, MD, 12901 Bruce B Downs Blvd, MDC73, Tampa, FL 33612. E-mail: [email protected]

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David K. Lerner MD,

David K. Lerner MD

orcid.org/0000-0002-0431-2920

Department of Otolaryngology–Head and Neck Surgery, Icahn School of Mount Sinai, New York City, New York, U.S.A.

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Jordan T. Glicksman MD, MPH,

Jordan T. Glicksman MD, MPH

orcid.org/0000-0002-9076-6557

Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.

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Stephen P. Miranda MD,

Stephen P. Miranda MD

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Ryan Dimentberg BS,

Ryan Dimentberg BS

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Darren Ebesutani BA,

Darren Ebesutani BA

Office of Clinical Research, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Michael Kohanski MD, PhD,

Michael Kohanski MD, PhD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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John Y. K. Lee MD, MSCE,

John Y. K. Lee MD, MSCE

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Phillip B. Storm MD,

Phillip B. Storm MD

Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.

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Bert W. O'Malley Jr. MD,

Bert W. O'Malley Jr. MD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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James N. Palmer MD,

James N. Palmer MD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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M. Sean Grady MD,

M. Sean Grady MD

Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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Nithin D. Adappa MD,

Nithin D. Adappa MD

Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

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First published: 24 August 2020

https://doi.org/10.1002/lary.29041

Citations: 18

Editor's Note: This Manuscript was accepted for publication on July 31, 2020.

The authors have no financial disclosures or conflicts of interest to declare.

Presented as an oral presentation at RhinoWorld, June 5–9, 2019, in Chicago, IL.

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Abstract

Objective

To characterize the patient and clinical factors that determine variability in hospital costs following endoscopic transphenoidal pituitary surgery.

Methods

All endoscopic transphenoidal pituitary surgeries performed from January 1, 2015, to October 24, 2017, with complete data were evaluated in this retrospective single-institution study. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables during each hospital stay. Multivariate linear regression was performed using Stata software.

Results

The analysis included 190 patients and average length of stay was 4.71 days. Average total in-hospital cost was $28,624 (95% confidence interval $25,094–$32,155) with average total direct cost of $19,444 ($17,136–$21,752) and total indirect cost of $9181 ($7592–$10,409). On multivariate regression, post-operative cerebrospinal fluid (CSF) leak was associated with a significant increase in all cost variables, including a total cost increase of $40,981 ($15,474–$66,489, P = .002). Current smoking status was associated with an increased total cost of $20,189 ($6,638–$33,740, P = .004). Self-reported Caucasian ethnicity was associated with a significant decrease in total cost of $6646 (−$12,760 to −$532, P = .033). Post-operative DI was associated with increased costs across all variables that were not statistically significant.

Conclusions

Post-operative CSF leak, current smoking status, and non-Caucasian ethnicity were associated with significantly increased costs. Understanding of cost drivers of endoscopic transphenoidal pituitary surgery is critical for future cost control and value creation initiatives.

Level of Evidence

3 Laryngoscope, 131:760–764, 2021

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Citing Literature

Volume131, Issue4

April 2021

Pages 760-764

Drivers of In-Hospital Costs Following Endoscopic Transphenoidal Pituitary Surgery

Abstract

Objective

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Drivers of In-Hospital Costs Following Endoscopic Transphenoidal Pituitary Surgery

Abstract

Objective

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

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