Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Chern, Alexander; Hunter, Jacob B.; Bennett, Marc L.
• Is Part Of: Otology & neurotology. Volume 38:Issue 1(2017)
• Page Start: 147
• Page End: 151
• Publication Date: 2017-01
• Subjects: Acoustic neuroma -- Cerebellopontine angle surgery -- Cerebrospinal fluid leak -- Cost-effectiveness -- Resorbable mesh cranioplasty -- Vestibular schwannoma; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000001252
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. Study Design: Retrospective case series. Patients: One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. Intervention: Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. Results: One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65–$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28–$111404.55). The median cost of a CSF leak was $50401.25 (range, $0–$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. Conclusion: Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.