Driversofin-Hospitalcosts Following Endoscopic Transphenoidal Pituitary Surgery

Objective To characterize the patient and clinical factors that determine variability in hospital costs following endoscopic transphenoidal pituitary surgery. Methods All endoscopic transphenoidal pituitary surgeries performed from January 1, 2015, to October 24, 2017, with complete data were evaluated in this retrospective single-institution study. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables during each hospital stay. Multivariate linear regression was performed using Stata software. Results The analysis included 190 patients and average length of stay was 4.71 days. Average total in-hospital cost was $28,624 (95% confidence interval $25,094-$32,155) with average total direct cost of $19,444 ($17,136-$21,752) and total indirect cost of $9181 ($7592-$10,409). On multivariate regression, post-operative cerebrospinal fluid (CSF) leak was associated with a significant increase in all cost variables, including a total cost increase of $40,981 ($15,474-$66,489,P= .002). Current smoking status was associated with an increased total cost of $20,189 ($6,638-$33,740,P= .004). Self-reported Caucasian ethnicity was associated with a significant decrease in total cost of $6646 (-$12,760 to -$532,P= .033). Post-operative DI was associated with increased costs across all variables that were not statistically significant. Conclusions Post-operative CSF leak, current smoking status, and non-Caucasian ethnicity were associated with significantly increased costs. Understanding of cost drivers of endoscopic transphenoidal pituitary surgery is critical for future cost control and value creation initiatives. Level of Evidence 3Laryngoscope, 2020