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Published on: July 5, 2021
The costs of skull base surgery in the pediatric population
A L Stapleton1, E C Tyler-Kabara2, P A Gardner2
1Department of Otolaryngology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States.
Insights
Endoscopic endonasal surgery (EES) is a cost-effective approach for pediatric skull base lesions, with average costs around $34,056. Costs vary by specific pathology and treatment complexity.
Area of Science:
- Otolaryngology
- Pediatric Neurosurgery
- Health Economics
Background:
- Skull base lesions in pediatric patients present unique surgical challenges.
- Endoscopic endonasal surgery (EES) has emerged as a minimally invasive alternative for accessing skull base pathologies.
Purpose of the Study:
- To determine the economic costs associated with endoscopic endonasal surgery (EES) for pediatric skull base lesions.
- To analyze cost variations based on lesion type, surgical complexity, and patient outcomes.
Main Methods:
- Retrospective chart review of 160 pediatric patients (1 month to 19 years) undergoing EES for skull base lesions between 1999 and 2013.
- Analysis of demographic, operative, and financial data, including surgical day, intensive care unit (ICU), floor, and total inpatient costs.
- Calculation of average costs per patient and per day for different care settings.
Main Results:
- The average total inpatient and surgical cost was $34,056 per patient.
- Angiofibromas incurred the highest costs ($59,051), while fibro-osseous lesions were least expensive ($10,931).
- Average ICU stay was 1.8 days ($4,577/day), acute care stay was 3.4 days ($1,961/day), with an overall length of stay of 4.5 days.
Conclusions:
- Endoscopic endonasal surgery (EES) represents a cost-effective surgical model for pediatric skull base lesions.
- Significant cost variations exist, influenced by specific pathology, staged procedures, ICU duration, and the necessity for re-operation.
Abstract:
Objectives To determine the costs of endoscopic endonasal surgery (EES) for pediatric skull base lesions. Methods Retrospective chart review of pediatric patients (ages 1 month to 19 years) treated for skull base lesions with EES from 1999 to 2013. Demographic and operative data were recorded. The cost of care for the surgical day, intensive care unit (ICU), floor, and total overall cost of inpatient stay were acquired from the finance department. Results A total of 160 pediatric patients undergoing EES for skull base lesions were identified. Of these, 55 patients had complete financial data available. The average total inpatient and surgical costs of care were $34, 056 per patient. Angiofibromas were the most costly: $59,051 per patient. Fibro-osseous lesions had the lowest costs: $10,931 per patient. The average ICU stay was 1.8 days at $4,577 per ICU day. The average acute care stay was 3.4 days at $1,961 per day. Overall length of stay was 4.5 days. Three cerebrospinal fluid leaks (4%) and two cases of meningitis (3%) occurred. One tracheostomy was required (1.5%). Conclusions EES is a cost-effective model for removal of skull base lesions in the pediatric population. Costs of care vary according to pathology, staged surgeries, length of ICU stay, and need for second operations.
