Author(s)
Joe Saliba, MD, MS
Amir Mohammadzadeh, MS
Kareem O. Tawfik, MD
Mihir Gupta, MD
Marc S. Schwartz, MD
Quyen T. Nguyen, MD, PhD
Rick A. Friedman, MD, PhD
Affiliation(s)
UC-San Diego Health
Abstract:
Objective: To determine the surgical costs associated with the translabyrinthine (TL), retrosigmoid (RS) andmiddle cranial fossa (MCF) approaches for the microsurgical excision of vestibular schwannoma (VS).Study Design: Retrospective cost analysis study.Setting: Tertiary referral center.Patients: Twenty-one consecutive adult patients underwent microsurgical excision of VS by either TL (n=7), RS(n=7) or MCF (n=7) approach. Tumors were restricted to size between 1-2.5 cm. Patients with a history ofneurofibromatosis 2, preoperative radiosurgery, or previous surgical resection were excluded.Interventions: Patients underwent microsurgical excision of VS by one of the three major approaches. Surgicalreceipts were collected for each patient. Analysis of variance was performed to compare surgical costs betweenapproaches.Main outcome measures: Surgical supply costs (US$), total room time (minutes) and skin-to-skin operating time(minutes).Results: The mean surgical supply cost was lowest for MCF and highest for RS ($3013.85 and $7966.39,respectively, p=0.003). Mean supply cost was $4295.51 for the TL approach. The items associated with the highestaverage cost per case were the surgical aspirator ($1020), drill burs ($930.80) and titanium implants ($620). Therewas redundancy in multiple surgical items such as drill burs and hemostatic agents. On average, total room timefor all approaches was 85.8 min longer than skin-to-skin time.Conclusion: This study is the first to examine the surgical expenses associated with VS resection. Reduction insupply redundancy provides the opportunity for decreasing surgical costs and waste. Future analyses will includetotal surgical day costs, intensive care unit and total admission costs.Define Professional Practice Gap & Educational Need: Lack of awareness of surgical costs associated withlateral skull base approachesLearning Objective: To compare and break down the surgical costs associated with the translabyrinthine,retrosigmoid and middle cranial fossa approaches for the microsurgical excision of vestibular schwannoma.Ultimately the long term goal is to reduce surgical costs and surgical waste.Desired Result: Increase their awareness about the costs of surgical supplies, and potentially have more conservativerequests in their upcoming cases.Level of Evidence - Level III - Cohort and case-control studiesIndicate IRB or IACUC Approval: Approved