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J Neurol Surg B Skull Base
DOI: 10.1055/a-2607-0611
Original Article

How Expensive is ENT Surgeons' Involvement in Retrosigmoid Craniotomies? A Time-Driven Activity-Based Cost Analysis

Danyal A. Quraishi 
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
2   Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
,
D Mitchell Self
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Steven Glener
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Advith Sarikonda
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Neerav Kumar
3   Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, United States
,
Emily L. Isch
4   Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Matthews Lan 
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Arbaz Momin
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Ashmal Sami Kabani 
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
James J. Evans
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Kevin D. Judy
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Nicholas Clark
5   Department of Spine Surgery, Hospital for Special Surgery at NCH, Naples, Florida, United States
,
Christopher J. Farrell
1   Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, United States
,
Ahilan Sivaganesan
5   Department of Spine Surgery, Hospital for Special Surgery at NCH, Naples, Florida, United States
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Abstract

Objective

This study aims to examine the impact of ear, nose, and throat (ENT) surgeons' involvement on intraoperative costs and operating room (OR) times for retrosigmoid craniotomies using time-driven activity-based costing (TDABC).

Design

A retrospective, single-center analysis was conducted. TDABC methodology was utilized to calculate total intraoperative costs. Multiple linear regression analysis was performed to assess the independent effect of ENT surgeons' involvement on surgical costs and OR time.

Setting

All procedures were performed at the Thomas Jefferson University Hospital and affiliated sites between 2017 and 2022.

Participants

About 255 patients underwent retrosigmoid craniotomy (166 neurosurgery only, 89 with ENT surgeons' involvement).

Main Outcome Measures

Main outcome measures include total intraoperative costs calculated using TDABC methodology, OR time, supply costs, and personnel costs.

Results

Inclusion of ENT surgeons was significantly associated with increased total costs (B = $4,082 ± $1,015, p < 0.001) and OR time (B = 135 ± 38 minutes, p < 0.001). The mean total cost of neurosurgery-only cases was $7,538 ± $3,977, compared with $14,217 ± $3,485 for multidisciplinary cases. Personnel costs were the primary driver of this increase, with no significant difference in supply costs between groups.

Conclusion

While ENT collaboration can enhance outcomes in select cases, such as those involving vestibular schwannomas, its routine inclusion may not be cost-effective. Our study demonstrates the marginal cost of ENT collaboration for retrosigmoid craniotomies. Future studies may build on our costing framework by integrating outcomes with costs to determine the true cost-effectiveness of cross-specialty collaboration.

Keywords

retrosigmoid craniotomy - ENT collaboration - time-driven activity-based costing - cost-effectiveness


Publication History

Received: 30 January 2025

Accepted: 12 May 2025

Accepted Manuscript online:
13 May 2025

Article published online:
22 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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