Enhancing Value of Pituitary Surgery by Maintaining Quality and Reducing Cost

Introduction: Our center performs approximately 60 endoscopic transnasal transsphenoidal (eTNTS) pituitary operations per year. Traditionally, for every operation we obtained intraoperative frozen section consultation (IFSC), used a dural sealant (DS), and obtained postoperative magnetic resonance imaging (MRI). Our objective was to enhance the value of the operation by optimizing the cost of hospitalization, while maintaining an equal quality of care.

Methods: Retrospective review of 257 patients who underwent eTNTS resection of newly diagnosed pituitary adenoma over a 4-year period. We implemented the exclusion of routine use of IFSC, DS, and postoperative MRI in the past year. Subsequent analysis of the effects of the optimization criteria on quality of care and cost was performed.

Results: Postoperative CSF leak rate after the cessation of DS usage remained unchanged at 3%. The results of permanent pathology were never different from the intraoperative differential diagnosis. The cost of an IFSC, DS, and brain MRI is $223, $829 and $1119, respectively. The per-patient cost optimization for pituitary surgery is at least $2,171. The annual cost optimization at the current volume is approximately $130,000.

Conclusions: We identified and implemented three optimization parameters into the care of patients undergoing pituitary surgery. By eliminating the routine use of intraoperative frozen section consultation, dural sealant, and postoperative MRI, we were able to significantly reduce costs, while maintaining the same quality of care for our patients. Any of the three items are still being utilized in unusual or difficult cases.