scholarly journals Use of Tissue Glues in Endoscopic Pituitary Surgery: A Cost Comparison

2010 ◽  
Vol 37 (5) ◽  
pp. 650-655 ◽  
Author(s):  
Lukas H. Kus ◽  
Brian W. Rotenberg ◽  
Neil Duggal
Keyword(s):  
Cost Analysis ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Significant Proportion ◽  
Pituitary Surgery ◽  
Csf Leak ◽  
Dural Repair ◽  
Surgical Sealant ◽  
Clinical Scenarios ◽  
Consensus Values

Background:Post-operative cerebrospinal fluid (CSF) leaks are a common complication of endoscopic pituitary surgery and account for a significant proportion of hospital costs associated with this procedure. Tisseel® is a tissue glue commonly used as an adjunct in dural repair but is not optimal for this purpose. DuraSeal® has several properties advantageous for dural repair but is not widely accepted in Canada partly due to its increased cost.Objective:A cost analysis of DuraSeal® versus Tisseel® in endoscopic pituitary surgery.Methods:A cost analysis was performed based on typical endoscopic pituitary surgery cases performed at our tertiary care institution. Operating room, hospital admission, and surgical sealant costs were obtained directly while estimates of patient recovery time and post-operative CSF leak rates were based on consensus values reported in the literature. Outcomes were reported for various possible clinical scenarios of sealant use.Results:In a model where surgical sealant is employed only in high-risk cases, use of DuraSeal® allows for a yearly cost savings of at least $4486.72. If surgical sealant is used in all cases, regular use of DuraSeal® versus Tisseel® either marginally reduces yearly costs or increases them by a maximum of $7619.25, depending on the case volume and estimated post-operative CSF leak rate.Conclusion:In most clinical scenarios, use of DuraSeal® in endoscopic pituitary surgery may reduce overall yearly hospital costs compared to Tisseel®.

scholarly journals An Investigation of a Novel Dural Repair Device for Intraoperative Incidental Durotomy Repair

2021 ◽  
Vol 8 ◽  
Author(s):  
Kartik Shenoy ◽  
Chester J. Donnally ◽  
Evan D. Sheha ◽  
Krishn Khanna ◽  
Srinivas K. Prasad
Keyword(s):  
Simulation Model ◽  
Csf Leak ◽  
The Novel ◽  
Clinical Experiences ◽  
Dural Repair ◽  
Novel Device ◽  
Clinical Scenarios ◽  
Dural Tears ◽  
Incidental Durotomy ◽  
Tools And Techniques

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair time, CSF leak pressure and nerve root avoidance in the simulation. The results were generally replicable clinically, however, numerous additional clinical scenarios were also encountered that the simulation model was unable to capture due to various inherent limitations. The simulation model design, potential contributors to watertightness, clinical experiences, and limitation are discussed.

scholarly journals Costs and Perioperative Outcomes Associated with Open versus Endoscopic Resection of Sinonasal Malignancies with Skull Base Involvement

2017 ◽  
Vol 78 (05) ◽  
pp. 430-440 ◽  
Author(s):  
Terence Fu ◽  
Eric Monteiro ◽  
Ian Witterick ◽  
Allan Vescan ◽  
Gelareh Zadeh ◽  
...  
Keyword(s):  
Free Flap ◽  
Operative Time ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Hospital Costs ◽  
Csf Leak ◽  
Perioperative Outcomes ◽  
Care Hospital ◽  
Icu Admission ◽  
Sinonasal Malignancies

Objective To compare financial and perioperative outcomes between endoscopic and open surgical approaches in the surgical management of sinonasal malignancies. Design Retrospective chart review. Setting Tertiary care hospital. Participants Patients undergoing surgical resection of a sinonasal malignancy from January 2000 to December 2014. Main Outcome Measures In-hospital costs, complications, and length of stay (LOS). Results Of 106 patients, 91 received open surgery (19 free flap and 72 non-free flap) and 15 were treated with purely endoscopic approaches. Free flaps had a significantly higher average cost, operative time, and LOS compared to both non-free flap (p < 0.001, < 0.001, and < 0.01) and endoscopic (p = 0.01, 0.04, and < 0.01) groups. There were no significant differences in average costs between endoscopic and non-free flap groups ($19,157 vs. $14,806, p = 0.20) or LOS (5.7 vs. 6.4 days, p = 0.72). Compared with the non-free flap group, the endoscopic group had a longer average operative time (8.3 vs. 5.5 hours, p < 0.01) and higher rates of cerebrospinal fluid (CSF) leak (13 vs. 0%, p = 0.01) and intensive care unit (ICU) admission (80 vs. 36%, p < 0.01). Surgical approach (open vs. endoscopic) was not a significant predictor of any financial or perioperative outcome on multivariable analysis. Conclusion Hospital costs are comparable between endoscopic and open approaches when no free tissue reconstruction is required. Longer operative times, higher CSF leak rates, and our institutional protocol necessitating ICU admission for endoscopic cases may account for the failure to demonstrate cost savings with endoscopic surgery.

Simulation of Cerebrospinal Fluid Leak Repair Using a 3-Dimensional Printed Model

2021 ◽  
pp. 194589242110035
Author(s):  
Muhamed A. Masalha ◽  
Kyle K. VanKoevering ◽  
Omar S. Latif ◽  
Allison R. Powell ◽  
Ashley Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Great Part ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Clinical Environment ◽  
Training Tool ◽  
3 Dimensional ◽  
Clinical Scenarios ◽  
Before And After ◽  
3D Printed

Background Acquiring proficiency for the repair of a cerebrospinal fluid (CSF) leak is challenging in great part due to its relative rarity, which offers a finite number of training opportunities. Objective The purpose of this study was to evaluates the use of a 3-dimensional (3D) printed, anatomically accurate model to simulate CSF leak closure. Methods Volunteer participants completed two simulation sessions. Questionnaires to assess their professional qualifications and a standardized 5-point Likert scale to estimate the level of confidence, were completed before and after each session. Participants were also queried on the overall educational utility of the simulation. Results Thirteen otolaryngologists and 11 neurosurgeons, met the inclusion criteria. A successful repair of the CSF leak was achieved by 20/24 (83.33%), and 24/24 (100%) during the first and second simulation sessions respectively (average time 04:04 ± 1.39 and 02:10 ± 01:11). Time-to-close-the-CSF-leak during the second session was significantly shorter than the first (p < 0.001). Confidence scores increased across the training sessions (3.3 ± 1.0, before the simulation, 3.7 ± 0.6 after the first simulation, and 4.2 ± 0.4 after the second simulation; p < 0.001). All participants reported an increase in confidence and believed that the model represented a valuable training tool. Conclusions Despite significant differences with varying clinical scenarios, 3D printed models for cerebrospinal leak repair offer a feasible simulation for the training of residents and novice surgeons outside the constrictions of a clinical environment.

A Single Layer Synthetic Dural Substitute Inlay is an Effective Sellar Reconstruction Technique in Endoscopic Transsphenoidal Pituitary Surgery

2020 ◽  
Author(s):  
Mark B. Chaskes ◽  
Tawfiq Khoury ◽  
Chandala Chitguppi ◽  
Pascal Lavergne ◽  
Gurston G. Nyquist ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Tertiary Care ◽  
Single Layer ◽  
Csf Leak ◽  
Reconstruction Technique ◽  
Potential Cost ◽  
Lumbar Drainage ◽  
Dural Substitute ◽  
Sellar Reconstruction ◽  
Csf Leaks

Abstract Objectives A variety of endonasal sellar repair techniques have been described; many are complex, multilayered, and carry potential morbidity. We propose an effective, technically simple single-layer repair for select sellar defects, including those with an intraoperative cerebrospinal fluid (CSF) leak. Our technique utilizes only a synthetic dural substitute inlay and dural sealant glue without packing or lumbar drainage. Design This is a retrospective review-based study. Setting This study was conducted at tertiary care center. Participants Patients who underwent endoscopic transsphenoidal surgery for pituitary adenoma and sellar reconstruction with the aforementioned inlay technique. Patients were selected for this technique if they had an identified intraoperative CSF leak, a patulous diaphragm (expanded and thinned diaphragma sella), or a comorbidity excluding them from a simpler onlay only reconstruction. Outcome Measures Postoperative CSF leak and sinonasal morbidity included in the study Results A total of 409 subjects were identified; 368 were initial resections. Gross total resection of the pituitary adenoma was achieved in 356 (87.0%) cases. Average tumor size was 2.6 ± 1.1 cm. Average tumor volume was 10.8 ± 12.1 cm3. There were 135 intraoperative CSF leaks and 196 patulous diaphragms. There were five postoperative CSF leaks (1.2%), all of which occurred in the first half of our series. Pre- and postoperative sino-nasal outcomes test-22 scores were 19.2 ± 18.2 and 18.8 ± 21.3 (p = 0.492), respectively. Conclusion A synthetic dural substitute inlay and dural sealant glue is an excellent single-layer repair for sellar defects, even those with an intraoperative CSF leak. This technique is highly effective in preventing postoperative CSF leaks and does not utilize packing or lumbar drainage. It also avoids the potential cost and morbidity associated with more complex and multilayered closures.

A retrospective analysis of congenital anomalies in congenital hypothyroidism

2020 ◽  
Vol 33 (9) ◽  
pp. 1147-1153
Author(s):  
Fatima Ali Mazahir ◽  
Manal Mustafa Khadora
Keyword(s):  
United Arab Emirates ◽  
Congenital Hypothyroidism ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
High Rate ◽  
Lingual Thyroid ◽  
Cross Sectional

AbstractObjectivesWe evaluated the spectrum of diseases accompanying congenital hypothyroidism (CH) in the United Arab Emirates and compared them with internationally studied patterns.MethodsThe presented retrospective cross-sectional study took place in two government tertiary care centres. In total, 204 patients with a confirmed diagnosis of CH and a minimum period of follow-up of 1 year were included. Patients with Down syndrome, infants born at <35 weeks of gestation, and babies with TORCH (Toxoplasma gondii, Other viruses [HIV, measles, etc.], Rubella, Cytomegalovirus, and Herpes simplex) infections were subsequently excluded from the study.ResultsOf the subjects with CH, 39% had associated extrathyroidal anomalies (ETAs); among these, 25% had a single anomaly. A significant proportion of Arab males were affected by CH as compared to other ethnic groups. Dyshormonogenesis was the commonest aetiological cause (55%) of CH. Males with an ectopic lingual thyroid gland had significant ETAs as compared to females of the same cohort. The most common ETAs were congenital heart disease (16%), followed by urogenital tract anomalies (14%).ConclusionsDetection of a high rate and variability of ETAs associated with CH necessitates the formulation of a structured screening programme including appropriate clinical, laboratory, and imaging tools to detect ETAs at an earlier stage.

Safety and efficacy of the porcine small intestinal submucosa dural substitute: results of a prospective multicenter study and literature review

2007 ◽  
Vol 106 (6) ◽  
pp. 1028-1033 ◽  
Author(s):  
Ghassan K. Bejjani ◽  
Joseph Zabramski ◽  
_ _
Keyword(s):  
Wound Infection ◽  
Small Intestinal Submucosa ◽  
Csf Leak ◽  
Dural Repair ◽  
Dural Substitute ◽  
Csf Leakage ◽  
Porcine Small Intestinal Submucosa ◽  
Small Intestinal ◽  
Intestinal Submucosa

Object Dural substitutes are often needed after neurosurgical procedures to expand or replace dura mater resected during surgery. A new dural repair material derived from porcine small intestinal submucosa (SIS) was evaluated in a prospective multicenter clinical study. Methods Between 2000 and 2003, 59 patients at five different institutions underwent dural reconstruction with the SIS dural substitute, with a minimum follow up of 6 months. The primary goals of the study were to assess the efficacy and safety of the SIS dural substitute according to the rate of cerebrospinal fluid (CSF) leakage, infection, and meningitis. Chiari malformation Type I decompression (32 patients) and tumor resection (18 patients) were the most common procedures performed, with 81% of SIS grafts implanted in the posterior fossa or spine. There was one case of a CSF leak (1.7%), two cases of wound infection (3.4%), and no cases of bacterial meningitis (0%) in the 58 patients available for follow up. In both cases of wound infection, the SIS graft acted as a barrier to infection and was not removed. Intraoperatively, a watertight seal was achieved in all 59 cases. On follow-up imaging available in 27 patients there was no evidence of any adverse reaction to the graft or of cerebral inflammation. Conclusions The SIS dural substitute demonstrated substantial efficacy in these patients after a mean follow up of 7.3 ± 2.2 months. Rates of infection, CSF leakage, and meningitis were comparable to those reported for other dural substitute materials. A lack of adverse reactions to the graft, favorable safety profile, and clinical efficacy all point to the utility of this material as an alternative for dural repair.

Cost analysis and benefits of opt-out HIV testing at a tertiary care centre in northern India

2013 ◽  
Vol 25 (5) ◽  
pp. 341-347 ◽  
Author(s):  
Ranjana W Minz ◽  
Anju Khairwa ◽  
Ritu Aggarwal ◽  
Harwinder Kaur ◽  
Surjit Singh ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Hiv Testing ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Northern India ◽  
Opt Out

A STUDY ON DRUG UTILIZATION EVALUATION AND POTENTIAL DRUG RELATED PROBLEMS IN TYPE-2 DIABETES MELLITUS PATIENTS WITH CO-MORBIDITIES IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 42-46
Author(s):  
PRUDENCE A. RODRIGUES ◽  
DAWN TESLIN DAMIEN ◽  
MARY CECIL K. T. ◽  
NARESH KUMAR M. ◽  
RESHMA S. S. ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cost Analysis ◽  
Drug Utilization ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Related Problems

Objective: The objective of this study is to evaluate prescribing pattern, analyze drug-related problems, identify co-morbidities and complications in Type 2 Diabetes Mellitus patients and also to perform cost analysis of Biguanides, Sulfonylureas, Dipeptidyl Peptidase Inhibitors Methods: A Prospective observational study was done in General Medicine and Endocrinology Departments of PSG Hospitals. A total of 200 study subjects, including both inpatients and outpatients, above 18 y of age, prescribed with OHAs (Biguanides, Sulfonylureas and DPP4 inhibitors) were included in the study. Results: Diabetes was more prevalent among males. OHAs were most prescribed in the age group of 51-60 y. Hypertension (71%) was the most common comorbidity and Diabetic neuropathy (23%) was the most common complication found in the patients. Multidrug therapy (72.5%) was most prescribed in diabetic patients, followed by Biguanides. Hypoglycemia was the most prevalent ADR. Cost analysis showed that T. Linagliptin was of high cost and T. Glimepiride being the low cost. Using WHO core indicators prescribing patterns were assessed. Feedback was collected and results were reported to the physicians which showed rational utilization of drugs. Conclusion: The study on drug utilization conducted in a tertiary care hospital helped us to find out that prescribing trends seems to be progressing towards combination therapy, predominantly two-drug therapy

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