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Endoscopy is a non-surgical medical technique used to examine a person's internal organs and vessels. This lesson will focus on two types of endoscopic studies: bronchoscopy and thoracoscopy.
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
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Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries.

Aviv Spillinger1,2, Meredith Allen1,2, Patrick Karabon2

  • 1Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States.

Journal of Neurological Surgery. Part B, Skull Base
|July 14, 2022
PubMed
Summary

Routine preoperative type and screens (T/S) are not cost-effective for endonasal skull base surgeries. A selective T/S approach for high-risk patients could optimize resource allocation and reduce costs.

Keywords:
anterior skull baseblood grouping and crossmatchingblood lossblood transfusionskull base surgerysurgical

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Health Economics

Background:

  • Preoperative type and screens (T/S) are standard practice for many surgical procedures.
  • The cost-effectiveness of routine T/S for endonasal skull base surgeries remains unclear.
  • Identifying factors associated with blood transfusions is crucial for optimizing patient care and resource management.

Purpose of the Study:

  • To evaluate the cost-effectiveness of preoperative type and screens (T/S) for endonasal skull base procedures.
  • To identify patient and hospital factors associated with receiving blood transfusions.
  • To determine the incremental cost-effectiveness ratio (ICER) of preoperative T/S to prevent emergency-release transfusions (ERT).

Main Methods:

  • Retrospective analysis of the 2006-2015 National (nationwide) Inpatient Sample database.
  • Multivariate regression analysis to identify factors associated with blood transfusions.
  • Cost-effectiveness analysis using a willingness-to-pay threshold of $1,500.

Main Results:

  • A total of 93,105 cases were analyzed, with an overall transfusion rate of 1.89%.
  • Factors associated with transfusion included nonelective admission, anemia, coagulopathy, diabetes, liver disease, pulmonary circulation disorders, and metastatic cancer.
  • The ICER of preoperative T/S was $3,576 per ERT prevented, exceeding the willingness-to-pay threshold.

Conclusions:

  • Routine preoperative T/S is not a cost-effective strategy for endonasal skull base surgeries based on national data.
  • A selective T/S policy targeting high-risk patients may be a more cost-effective approach.
  • Further research could explore specific high-risk criteria to guide selective T/S implementation.