Logo image
Back
Drivers of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis
Journal article   Open access   Peer reviewed

Drivers of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis

Advith Sarikonda, Danyal Quraishi, Steven Glener, D. Mitchell Self, Karim Hafazalla, Emily Isch, Ashmal Sami, Cheritesh Amaravadi, Faisal Shaikh, Kevin D. Judy, …
World neurosurgery, v 196, 123792
01 Apr 2025
DOI: https://doi.org/10.1016/j.wneu.2025.123792
PMID: 39956370
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.wneu.2025.123792View
Published, Version of Record (VoR) Open

Abstract

Pituitary TDABC Value-based care
Neurosurgeons lack precise insights into the true costs of transsphenoidal endoscopic surgery for sellar and suprasellar lesions (TESS), including pituitary adenomas, craniopharyngiomas, and apoplexy. To address this critical knowledge gap, we employ time-driven activity-based costing (TDABC) for TESS. We analyzed 221 TESS procedures performed between 2017 and 2022 at a large academic medical center. Costs were calculated using TDABC. Software was developed to extract information regarding all resources utilized intraoperatively. Supply cost was calculated as the aggregate of expenses related to implants, consumables, medications, and surgical tray sterilization. Personnel cost was determined by multiplying the per-minute wages of all intraoperative personnel by the amount of time they spent in the operating room. Patient and disease-specific variables were collected. Multivariable regression models were performed to assess predictors of cost. The average total cost of a TESS procedure was $7557 ± $2,365, with primary cost drivers being supplies ($2,811, 37%) and personnel ($4,426, 59%). On multivariable regression, factors independently associated with higher total cost were hospital site (β-coefficient: $1,028, P < 0.001), intraoperative blood loss (β-coefficient: $12, P < 0.001), length of stay (β-coefficient: $23, P = 0.015), and the use of a nasoseptal flap (β-coefficient: $731, P = 0.012). Conversely, apoplexy was associated with lower total cost (β-coefficient: $−1,149, P = 0.001), which was explained by faster operating room times and lower personnel cost (β-coefficient: $−702, P = 0.003). This study represents the first application of intraoperative TDABC for transsphenoidal endoscopic surgery. Such efforts can promote value-based healthcare by identifying areas for cost reduction and surgical resource management.

Metrics

1 Record Views
6 citations in Web of Science

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

Source: SDGs in the Output

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Surgery
Logo image