In-hospital Costs Associated with an Expanded Endonasal Approach to Anterior Skull Base Tumors

Introduction: Endoscopic anterior skull base surgery is a commonly performed operation that represents a substantial contributor to United States health care costs. Over recent years, an expanded endonasal approach (EEA) to the anterior skull base has been more frequently employed in the resection of complicated skull base tumors. In our study, we seek to quantify the in-hospital cost of this procedure and characterize any differences in cost breakdown relative to a standard transsphenoidal approach.

Methods: All endoscopic anterior skull base surgeries performed at this institution over a period from January 1, 2015, to October 24, 2017, were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and multivariate linear regression was performed using R software.

Results: An EEA to anterior skull base tumor resection was associated with a significantly greater in-hospital cost of $14,912 (p = 0.002). An EEA was associated with significant increases in total direct cost of $9,686 (p = 0.002), fixed indirect cost of $5,227 (p = 0.002), variable direct supply labor cost of $4,385 (p = 0.001), variable direct supply cost of $2,331(p = 0.011), and fixed direct cost of $2,970 (p = 0.003).

Discussion: An EEA was associated with significantly greater in-hospital costs than a standard transsphenoidal approach to anterior skull base tumor resection. Total direct costs drove a majority of this difference but costs were increased across all variables analyzed.