Drivers of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis.
Publication/Presentation Date
4-1-2025
Abstract
BACKGROUND: Neurosurgeons lack precise insights into the true costs of transsphenoidal endoscopic surgery for sellar and suprasellar lesions (TESS), including pituitary adenomas, craniopharyngiomas, and apoplexy. To address this critical knowledge gap, we employ time-driven activity-based costing (TDABC) for TESS.
METHODS: We analyzed 221 TESS procedures performed between 2017 and 2022 at a large academic medical center. Costs were calculated using TDABC. Software was developed to extract information regarding all resources utilized intraoperatively. Supply cost was calculated as the aggregate of expenses related to implants, consumables, medications, and surgical tray sterilization. Personnel cost was determined by multiplying the per-minute wages of all intraoperative personnel by the amount of time they spent in the operating room. Patient and disease-specific variables were collected. Multivariable regression models were performed to assess predictors of cost.
RESULTS: The average total cost of a TESS procedure was $7557 ± $2,365, with primary cost drivers being supplies ($2,811, 37%) and personnel ($4,426, 59%). On multivariable regression, factors independently associated with higher total cost were hospital site (β-coefficient: $1,028, P < 0.001), intraoperative blood loss (β-coefficient: $12, P < 0.001), length of stay (β-coefficient: $23, P = 0.015), and the use of a nasoseptal flap (β-coefficient: $731, P = 0.012). Conversely, apoplexy was associated with lower total cost (β-coefficient: $-1,149, P = 0.001), which was explained by faster operating room times and lower personnel cost (β-coefficient: $-702, P = 0.003).
CONCLUSIONS: This study represents the first application of intraoperative TDABC for transsphenoidal endoscopic surgery. Such efforts can promote value-based healthcare by identifying areas for cost reduction and surgical resource management.
Volume
196
First Page
123792
Last Page
123792
ISSN
1878-8769
Published In/Presented At
Sarikonda, A., Quraishi, D., Glener, S., Self, D. M., Hafazalla, K., Isch, E., Sami, A., Amaravadi, C., Shaikh, F., Judy, K. D., Evans, J. J., Clark, N., Farrell, C. J., & Sivaganesan, A. (2025). Drivers of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis. World neurosurgery, 196, 123792. https://doi.org/10.1016/j.wneu.2025.123792
Disciplines
Medicine and Health Sciences
PubMedID
39956370
Department(s)
Department of Surgery
Document Type
Article