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  • National Treatment Trends, Complications and Predictors of Resource Utilization in the Surgical Management of Adult Craniopharyngiomas from 2007-2011

    Final Number:

    Authors:
    Hasan Aqdas Zaidi BS MD; Kristina Chapple PhD; Andrew S. Little MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Treatment of craniopharyngiomas is one of the most surgically demanding and controversial neurosurgical diagnoses. We sought to evaluate national treatment trends for the disease and to determine factors associated with resource utilization to identify possible opportunities for improving healthcare economics.

    Methods: We analyzed the Nationwide Inpatient Sample (NIS) hospital discharge database from 2007 to 2011 to examine national treatment trends for adults (>18 years) who had undergone surgery for craniopharyngioma. A multistep regression model was developed that adjusted for patient demographics, acuity measures, comorbidities, hospital characteristics, and complications to predict the drivers of resource utilization.

    Results: 606 patients underwent surgical resection of craniopharyngioma, 353 by a transsphenoidal approach and 253 by a transcranial approach. The mean age was 47.7 ± 16.3 years. The average hospital length of stay was 7.6 ± 9 days. The mean hospital charge was $92,300 ± 83,356. Fifty-three percent of patients experienced diabetes insipidus or an electrolyte abnormality. A multivariate regression model demonstrated that length of stay (LOS), year of surgery, hospital volume, postoperative complications, comorbidities, and surgical approach emerged as significant predictors of resource utilization. The proposed model accounted for 54% of hospital charge variance.

    Conclusions: This analysis of hospital charges in craniopharyngioma surgery sheds light on the drivers of resource utilization. It also presents a review of national surgical outcomes for the disease.

    Patient Care: With a better understanding of the drivers of in-hospital charges for craniopharyngiomas, targeted efforts to reduce cost of care may help to provide fiscally responsible care to patients at the national level.

    Learning Objectives: Craniopharyngiomas are surgically challenging lesions which necessitate a multidisciplinary approach to pre- and post-operative care. Until now, national treatment trends and resource utilization have not been well studied. This data provides a snapshot of inpatient mortality rates, complication rates, and patient characteristics. After accounting for demographic information, patient acuity variables, hospital characteristics and complications, we found several clinical variables associated with in-hospital charges for craniopharyngiomas, such as length of stay, institutional volume, complications, and patient comorbidities. Identification of drivers of resource utilization may help improve efforts to optimize resource utilization.

    References: 1. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM. The descriptive epidemiology of craniopharyngioma. Journal of Neurosurgery 1998;89:547–51. 2. Karavitaki N, Brufani C, Warner JT, et al. Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clinical Endocrinology (Oxford) 2005;62:397–409. 3. Barker FG II, Klibanski A, Swearingen B: Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 88:4709–4719, 2003

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