Analysis of direct costs of decompressive craniectomy in patients victims of traumatic brain injury

Introduction: Decompressive craniectomy (DC) is a procedure required in some cases of traumatic brain injury (TBI) especially when diffuse lesions occur. This neurosurgical procedure aims to decrease the intracranial pressure through skullcap removal. These patients usually presented to emergency department with moderate or severe TBI (evaluated though GCS) and require intensive care. Besides this initial procedure, posteriorly all of them will require cranioplasty (with autologous bone or synthetic prosthesis) and many of them also require ventriculoperitoneal shunt because of the hydrodynamic changes.

Objective: This manuscript aims to evaluate the direct costs and outcomes of DC for TBI patients in a developing country and describe the epidemiological profile.

Methods: A retrospective study was performed using neurosurgical database of five years considering a sample of patients with TBI that underwent to DC. During this period a total of 133 DC for TBI were performed. A random selection of 32 patients with a TBI diagnosis, who underwent decompressive craniectomy, were selected. Several variables were considered and a formula was developed for calculating the direct total cost.

Results: Most patients had multiple brain lesions and the majority evolved with some infectious complication (69%). The general mortality index was 68,75%. The total cost was R$ 2.116.960,22 and the mean patient cost was R$ 66,155.00.

Conclusions: DC for TBI is an expensive procedure also associated to high morbidity and mortality. This was the first study performed in a non-developed country and future researches should be performed for trying to find other therapeutic approaches.