The Costs of Skull Base Surgery in the Pediatric Population
09 April 2014
16 June 2014
13 September 2014 (eFirst)
Objectives To determine the costs of endoscopic endonasal surgery (EES) for pediatric skull base lesions.
Methods Retrospective chart review of pediatric patients (ages 1 month to 19 years) treated for skull base lesions with EES from 1999 to 2013. Demographic and operative data were recorded. The cost of care for the surgical day, intensive care unit (ICU), floor, and total overall cost of inpatient stay were acquired from the finance department.
Results A total of 160 pediatric patients undergoing EES for skull base lesions were identified. Of these, 55 patients had complete financial data available. The average total inpatient and surgical costs of care were $34, 056 per patient. Angiofibromas were the most costly: $59,051 per patient. Fibro-osseous lesions had the lowest costs: $10,931 per patient. The average ICU stay was 1.8 days at $4,577 per ICU day. The average acute care stay was 3.4 days at $1,961 per day. Overall length of stay was 4.5 days. Three cerebrospinal fluid leaks (4%) and two cases of meningitis (3%) occurred. One tracheostomy was required (1.5%).
Conclusions EES is a cost-effective model for removal of skull base lesions in the pediatric population. Costs of care vary according to pathology, staged surgeries, length of ICU stay, and need for second operations.
- 1 Rigante M, Massimi L, Parrilla C , et al. Endoscopic transsphenoidal approach versus microscopic approach in children. Int J Pediatr Otorhinolaryngol 2011; 75 (9) 1132-1136
- 2 Hayhurst C, Williams D, Yousaf J, Richardson D, Pizer B, Mallucci C. Skull base surgery for tumors in children: long-term clinical and functional outcome. J Neurosurg Pediatr 2013; 11 (5) 496-503
- 3 Massimi L, Rigante M, D'Angelo L , et al. Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery. Acta Neurochir (Wien) 2011; 153 (4) 843-849
- 4 Banu MA, Guerrero-Maldonado A, McCrea HJ , et al. Impact of skull base development on endonasal endoscopic surgical corridors. J Neurosurg Pediatr 2014; 13 (2) 155-169
- 5 Teo C, Dornhoffer J, Hanna E, Bower C. Application of skull base techniques to pediatric neurosurgery. Childs Nerv Syst 1999; 15 (2–3) 103-109
- 6 Brockmeyer D, Gruber DP, Haller J, Shelton C, Walker ML. Pediatric skull base surgery. 2. Experience and outcomes in 55 patients. Pediatr Neurosurg 2003; 38 (1) 9-15
- 7 Lewark TM, Allen GC, Chowdhury K, Chan KH. Le Fort I osteotomy and skull base tumors: a pediatric experience. Arch Otolaryngol Head Neck Surg 2000; 126 (8) 1004-1008
- 8 Demonte F, Moore BA, Chang DW. Skull base reconstruction in the pediatric patient. Skull Base 2007; 17 (1) 39-51
- 9 Cloutier T, Pons Y, Blancal JP , et al. Juvenile nasopharyngeal angiofibroma: does the external approach still make sense?. Otolaryngol Head Neck Surg 2012; 147 (5) 958-963
- 10 Snyderman CH, Pant H, Carrau RL, Gardner P. A new endoscopic staging system for angiofibromas. Arch Otolaryngol Head Neck Surg 2010; 136 (6) 588-594
- 11 Kassam A, Thomas AJ, Snyderman C , et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, Suppl): 75-86
- 12 Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC. Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 2013; 11 (3) 227-241