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Published on: August 11, 2015
How Expensive is ENT Surgeons' Involvement in Retrosigmoid Craniotomies? A Time-Driven Activity-Based Cost Analysis
Danyal A Quraishi1,2, D Mitchell Self1, Steven Glener1
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States.
Summary
Including ear, nose, and throat (ENT) surgeons in retrosigmoid craniotomies significantly increases operating room costs and time. Routine ENT involvement may not be cost-effective despite potential benefits in specific cases.
Area of Science:
- Neurosurgery
- Health Economics
- Surgical Cost Analysis
Background:
- Retrosigmoid craniotomy is a complex neurosurgical procedure.
- The involvement of multiple surgical specialties can impact procedural costs and efficiency.
- Understanding the cost drivers of multidisciplinary surgical approaches is crucial for resource allocation.
Purpose of the Study:
- To evaluate the impact of ear, nose, and throat (ENT) surgeon involvement on intraoperative costs and operating room (OR) times for retrosigmoid craniotomies.
- To determine the cost-effectiveness of routine ENT collaboration in these procedures using time-driven activity-based costing (TDABC).
Main Methods:
- Retrospective, single-center analysis of 255 retrosigmoid craniotomies (2017-2022).
- Time-driven activity-based costing (TDABC) methodology was employed to calculate total intraoperative costs.
- Multiple linear regression analysis assessed the independent effect of ENT surgeon involvement on costs and OR time.
Main Results:
- ENT surgeon involvement was significantly associated with increased total costs (+$4,082) and OR time (+135 minutes).
- Mean total cost for neurosurgery-only cases was $7,538, compared to $14,217 for cases with ENT involvement.
- Personnel costs were the primary driver of increased costs; supply costs did not differ significantly.
Conclusions:
- Routine ENT surgeon collaboration in retrosigmoid craniotomies is associated with significantly higher intraoperative costs and longer OR times.
- While beneficial for specific indications (e.g., vestibular schwannomas), routine multidisciplinary involvement may not be cost-effective.
- Further research integrating outcomes with costs is needed to establish the true value of cross-specialty collaboration.