J Neurol Surg B Skull Base 2018; 79(02): 131-138
DOI: 10.1055/s-0037-1604484
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Comparative Cost Analysis of Endoscopic versus Microscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Chikezie Ikechukwu Eseonu
1   Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
Karim ReFaey
1   Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
Oscar Garcia
1   Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
Roberto Salvatori
3   Department of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
Alfredo Quinones-Hinojosa
1   Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
› Institutsangaben
Weitere Informationen


06. Februar 2017

17. Juni 2017

08. August 2017 (online)


Objective This study presents a comparative analysis of cost efficacy between the microscopic and endoscopic transsphenoidal approaches, evaluating neurological outcome, extent of resection (EOR), and inpatient hospital costs.

Design This study was a retrospective chart review.

Setting This study was conducted at a tertiary care center.

Participants The study group consisted of 68 patients with transsphenoidal surgeries between January 2007 and January 2014.

Main Outcome Measures Two-sample t-tests and Pearson's chi-square test evaluated inpatient costs, quality-adjusted life years (QALYs), volumetric EOR, and neurological outcomes.

Results Total inpatient costs per patient was $22,853 in the microscopic group and less ($19,736) in the endoscopic group (p = 0.049). Operating room costs were $5,974 in the microscopic group and lower in the endoscopic group ($5,045; p = 0.038). Operative time was 203.6 minutes in the microscopic group and 166.3 minutes in the endoscopic group (p = 0.032). The QALY score, length of hospital stay, and postoperative outcomes were found to be similar between the two cohorts. Multivariate linear regression modeling suggested that length of stay (p < 0.001) and operative time (p = 0.008) were important factors that influenced total inpatient costs following transsphenoidal surgery.

Conclusion This study shows that transsphenoidal surgery is more cost effective with the endoscopic approach than with the microscopic approach and depends on efficiency in the operating room as well as reduction in the length of hospitalization.

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