Comparative Cost Assessment of Transsphenoidal Surgery Closure Techniques: Are Biological Grafts and Glues Cost Effective?

Background: Pituitary surgery has greatly evolved since it was first described. Newer dural closure techniques involve direct repair with synthetic grafts and glues, which are individually more expensive items. Our objective is to assess whether the use of these new agents increases hospital charges and total costs pertaining to pituitary surgery.

Methods: We conducted a single center retrospective analysis of admissions for pituitary surgery at Thomas Jefferson University Hospital from June 2009 to June 2012. Clinical data, hospital costs and patient charges were collected for two hundred and three consecutive patients.

Results: Our population included 158 non-functional, 29 growth hormone, 13 adrenocorticotropic hormone, and 3 prolactin pituitary adenoma. Nineteen cases (9.4%) were re-operations; 15 (7.4%) presented with apoplexy. Our intra-operative CSF leak was 51/203 (25.1%); post-op was 4/203 (2%). Seventy-six patients had no dural repair; the surgical bed was simply layered with surgicel. One hundred and twenty patients had direct dural repair with dural graft and glue. The later group included the 51 patients with CSF leak and 21 with patulous diaphragm. Both groups had a similar population with an average length of stay of 4 days (median 2 days). We did not find a statistically significant difference in overall patient charges and hospital cost between patients treated with surgicel versus dural graft and glue. Average charges were respectively $92,829 vs $92,252 and total cost were $20,791 vs $20,763. The single most important variable to influence cost was length of stay (LOS). Looking specifically at the groups of patients with the shortest LOS (2days), we found a small difference in charges and cost. Total charges and costs were $72,038 and $16,223 in the surgicel group, versus $75,476 and $17,100 in the dural graft and glue group.

Conclusion: Dural grafts and glues are increasingly used in transsphenoidal surgery. While they individually cost more, other aspects of health care such as length of stay overshadows their financial impact on patient charges and hospital cost. We should however remain mindful of using them sparingly to repair CSF leaks.