Cost analysis of cerebrospinal fluid leaks and cerebrospinal fluid leak prevention in patients undergoing cerebellopontine angle surgery

Alexander Chern, Jacob B. Hunter, Marc L. Bennett

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objective: To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. Study Design: Retrospective case series. Patients: One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. Intervention: Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. Results: One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. Conclusion: Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.

Original languageEnglish (US)
Pages (from-to)147-151
Number of pages5
JournalOtology and Neurotology
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Acoustic neuroma
  • Cerebellopontine angle surgery
  • Cerebrospinal fluid leak
  • Costeffectiveness
  • Resorbable mesh cranioplasty
  • Vestibular Schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

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