In-hospital Costs Associated with Diabetes Insipidus Following Pituitary Surgery

Introduction: Diabetes Insipidus (DI) is among the most common complications of endoscopic pituitary resection and its management represents a substantial portion of in-hospital costs associated with pituitary surgery. In this study, we seek to quantify and characterize the in-hospital costs associated with DI following pituitary surgery.

Methods: All pituitary 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: Postoperative DI was associated with a total in-hospital cost of $14,436 per patient (p = 0.003). In terms of cost breakdown, DI was associated with an increase in fixed indirect cost of $4,864 (p = 0.004), total direct cost of $9,571 (p = 0.002), fixed direct of $2,899 (p = 0.003), and variable direct labor costs of $5,558 (p < 0.001). There was no significant difference in variable direct supply costs ($1,115, p = 0.225).

Discussion: Postoperative DI was associated with significantly greater in-hospital costs following pituitary surgery. Total direct costs comprise a majority of this difference, but additional cost variables including indirect, fixed direct, and variable direct labor costs are also elevated. These findings suggest that postoperative DI is a significant driver of in-hospital expenses associated with pituitary surgery. An effective endocrine protocol for identification and management of these patients may represent an opportunity for considerable cost savings.