Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries

Aviv Spillinger; Meredith Allen; Patrick Karabon; Houmehr Hojjat; Kerolos Shenouda; Inaya Hajj Hussein; Jeffrey T. Jacob; Peter F. Svider; Adam J. Folbe

doi:10.1055/s-0041-1730896

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2022; 83(S 02): e449-e458
DOI: 10.1055/s-0041-1730896

Original Article

Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries

Authors

Aviv Spillinger

¹Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States

²Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
Meredith Allen

¹Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States

²Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
Patrick Karabon

²Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
Houmehr Hojjat

³Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
Kerolos Shenouda

³Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
Inaya Hajj Hussein

²Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
Jeffrey T. Jacob

⁴Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan, United States
Peter F. Svider

⁵Department of Otolaryngology, Hackensack University Medical Center, Hackensack, New Jersey, United States
Adam J. Folbe

¹Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States

²Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States

³Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States

Abstract

Objective The study aimed to evaluate the cost-effectiveness of obtaining preoperative type and screens (T/S) for common endonasal skull base procedures, and determine patient and hospital factors associated with receiving blood transfusions.

Study Design Retrospective database analysis of the 2006 to 2015 National (nationwide) Inpatient Sample and cost-effectiveness analysis.

Main Outcome Measures Multivariate regression analysis was used to identify factors associated with transfusions. A cost-effectiveness analysis was then performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.

Results A total of 93,105 cases were identified with an overall transfusion rate of 1.89%. On multivariate modeling, statistically significant factors associated with transfusion included nonelective admission (odds ratio [OR]: 2.32; 95% confidence interval [CI]: 1.78–3.02), anemia (OR: 4.42; 95% CI: 3.35–5.83), coagulopathy (OR: 4.72; 95% CI: 2.94–7.57), diabetes (OR: 1.45; 95% CI: 1.14–1.84), liver disease (OR: 2.37; 95% CI: 1.27–4.43), pulmonary circulation disorders (OR: 3.28; 95% CI: 1.71–6.29), and metastatic cancer (OR: 5.85; 95% CI: 2.63–13.0; p < 0.01 for all). The ICER of preoperative T/S was $3,576 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S.

Conclusion Routine preoperative T/S does not represent a cost-effective practice for these surgeries using nationally representative data. A selective T/S policy for high-risk patients may reduce costs.

Keywords

skull base surgery - anterior skull base - blood transfusion - blood grouping and crossmatching - blood loss - surgical

Volltext

Referenzen

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