Economic Outcomes of Patients Undergoing Surgical Intervention for Trigeminal Neuralgia: Analysis from a National Database

Introduction: The surgical management of trigeminal neuralgia has evolved significantly in the past century. While microvascular decompression was the initial surgical treatment, percutaneous procedures, and stereotactic radiosurgery have played a large role in modern treatment of medically refractory trigeminal neuralgia. In the current manuscript, we compared clinical and economic outcomes of patients undergoing surgical intervention for trigeminal neuralgia between microvascular decompression (MVD), percutaneous rhizotomy or balloon compression, and stereotactic radiosurgery (SRS) using a national database.

Methods: The National Inpatient Sample (NIS) was queried for all patients with trigeminal neuralgia using international classification of disease 9th revision clinical modification (ICD-9-CM) diagnosis code (350.1) between the 1st quarter of 2002 and the 3rd quarter of 2015. Cases were also classified into surgical groups using ICD-9 procedure codes (ICD-9-PCS) including MVD (ICD-9-PCS code: 04.41, 04.02, 04.42, 02.06, 01.24, 01.25, 01.23), percutaneous procedures (04.2, 04.81, 99.29), and SRS (92.30, 92.31, 92.32, 92.33, 92.39). Outcomes assessed included length of stay (LOS), discharge disposition, and cost.

Results: A total of 8,317 patients undergoing a surgical intervention for trigeminal neuralgia were identified between 1st quarter of 2002 and the 3rd quarter of 2015, of which 7,202 (86.6%) underwent MVD, 548 (6.6%) underwent percutaneous procedures, and 567 (6.8%) underwent SRS. Patients undergoing percutaneous and SRS procedures were more likely to be older compared with those undergoing MVD (>65: 58.1 and 72.1% vs 32.2%, respectively; p < 0.001). MVD was more likely to be performed in an urban academic center, compared with percutaneous and SRS (84.8% vs. 75.1 and 75.8%, respectively; p < 0.001). Patients undergoing surgery in hospitals with a large bed size (>500 beds) were also more likely to have an MVD as compared with SRS and percutaneous procedures (79.9% vs. 75.0 and 64.0%; p < 0.001). Patients undergoing SRS had the lowest LOS (1.34 vs. 3.2 days and 3.5 days; p < 0.001). Patients undergoing percutaneous procedures had a significantly higher rate of non-routine discharge compared with patients in the MVD and SRS group (8.7 vs. 4.4% and 3.8%; p < 0.001). The total charges billed by the hospital were highest for patients undergoing MVD ($50,432.3) followed by those undergoing SRS ($38,450.9) and percutaneous procedures ($18,655.1) (p < 0.001). The total reimbursed cost was highest for SRS ($18,265.7) followed by MVD ($17,590.2) and percutaneous procedures ($8,183.3). Patients undergoing MVD were more likely to be covered by private insurance (55.7%) while patients undergoing SRS and percutaneous procedures were more likely to be covered by Medicare (76.5%, and 65.3%, respectively, overall p < 0.001).

Conclusion: In the current era of value-based care, these analyses are important in helping physicians, hospitals and other stake-holders devise appropriate policies to ensure optimal patient outcomes, as well as optimal physician and hospital reimbursements.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021