Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors

Abstract BACKGROUND: Minimally invasive spinal surgery (MIS) has emerged as a clinically effective tool but its cost-effectiveness remains unclear. No studies have compared MIS vs open surgical techniques for the treatment of intradural extramedullary (IDEM) tumors. OBJECTIVE: To analyze and compare open and MIS techniques for resection of IDEM tumors, with focus on perioperative costs. METHODS: Retrospective analysis of a prospectively collected database including 35 IDEM patients (18 open, 17 MIS). Perioperative data, hospital costs, and hospital and physician charges for in-hospital services associated with the index surgical procedure and readmissions within 90 days were compared. RESULTS: Mean estimated blood loss, operative time, preoperative hospital charges, and physician fees were similar between open and MIS techniques. Patient and tumor characteristics were similar between groups. MIS cases were associated with shorter intensive care unit and floor stay. There were 3 complications in the open group, requiring 2 readmissions and 1 reoperation. Hospital costs ($21 307.80 open, $15 015.20 MIS, P < .01), and postoperative ($75 383.48 open, $56 006.88 MIS, P < .01) and total charges ($100 779.38 open, $76 100.92 MIS, P < .01) were significantly lower in the MIS group. There were no tumor recurrences in either group. All patients except for one in the open group maintained or improved their Nurick score. CONCLUSION: Both MIS and open techniques were able to adequately treat IDEM tumors. Reductions in complication rate and intensive care unit and hospital stay led to a decrease in hospital costs of almost 30% in the MIS group. MIS resection of IDEM tumors is not only an effective and safe option, but allows faster hospital discharge and significant cost savings.

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PRENATAL DIAGNOSIS AND SURGICAL INNOVATIONS IN CONGENITAL DIAPHRAGMATIC HERNIA: EVALUATION OF PRE- AND POST-OPERATIVE MANAGEMENT

Journal of the Siena Academy of Sciences ◽

10.4081/jsas.2014.5816 ◽

2014 ◽

Vol 6 (1) ◽

Author(s):

R. Angotti ◽

F. Molinaro ◽

K. Bici ◽

E. Cerchia ◽

M. Sica ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prenatal Diagnosis ◽

Minimally Invasive ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Young Patients ◽

Surgical Techniques ◽

Female Ratio ◽

Access Surgery

Introduction. Congenital diaphragmatic hernia (CDH) is still today considered a challenge from surgeons. Considerable progress in prenatal diagnosis, intensive care unit of neonates and surgical techniques, with the possibility to perform minimally access surgery, widely increased survival rates. The aim of this study is to analyze our series about long and short-term outcomes, also considering the progress made by minimally invasive techniques. Methods. The study was performed at Pediatric Surgery of Siena. It is a retrospective study that analyzed all patients with CDH (Bochdalek) treated in the last 14 years, from 2000 to 2013. Sex, side of the defect, presence of prenatal diagnosis, age of onset and symptoms, associate malformation, herniated organs, surgical technique and site of surgery, complications, recurrences, survival and followup were analyzed. Results. We included 23 patients. Five of them, were ruled out because of affected by diaphragmatic eventration or acquired diaphragmatic hernia. Forteen patients (77%) presented left CDH and 4 patients (23%) a right one. The male female ratio were 14:4. Prenatal diagnosis was performed in 5 patients (27,5%) at a mean gestational age of 29 weeks. Forteen patients (77%) had an early onset of symptoms (first day of life). Most common symptoms were respiratory distress and cyanosis; 4 patients (23%) had a late onset of symptoms, at a mean age of 9 months, and most common symptoms were failure to thrive and vomiting. Seven patients (39%) had associated malformation: common mesenterium (5 pts-71%). The colon was the most commonly herniated organ, present in 15 patients (83%), followed by small intestine in 13 patients (72%), stomach in 11 patients (61%), spleen in 9 patients (50%) and liver in 4 patients (23%). Seventeen patients (94,5%) underwent open surgery: 10 of them (59%) underwent a subcostal laparotomy approach, 7 of them (41%) underwent a supraumbelical laparotomy approach; 1 patient (5%) underwent minimally access surgery with thoracoscopy access. We performed performed surgery in the intensive care unit in 3 patients (16,5%). Six patients (33%) developed minor postoperatory complications. No patient had recurrence. Four patients died so we report a mortality rate of 23%. A follow-up investigation, with an average duration of 87 months, it is still going on in 5 patients (27,5%). Conclusions. The our survival rate was 77% and it reflects the encouraging reported data in the recent literature. These results are due to the reliability of the new resuscitation strategies, such as high-frequency oscillatory ventilation and the use of NO, the ability to perform surgery in the neonatal intensive care unit and, especially, to successfully perform minimally invasive surgery in newborn. The improvement of the survival showed the increasing of long-term morbidity end the requirement of a multidisciplinary followup. For these reasons, a multidisciplinary pathway for the management of young patients has been created, to follow them in a standardized way as early as the prenatal diagnosis.

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Complication Risk in Primary and Revision Minimally Invasive Lumbar Interbody Fusion: A Comparable Alternative to Conventional Open Techniques?

Global Spine Journal ◽

10.1177/2192568219867289 ◽

2019 ◽

Vol 10 (5) ◽

pp. 619-626

Author(s):

Cole Bortz ◽

Haddy Alas ◽

Frank Segreto ◽

Samantha R. Horn ◽

Christopher Varlotta ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Postoperative Complications ◽

Propensity Score ◽

Minimally Invasive ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Perioperative Outcomes ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss

Study Design: Retrospective cohort study of prospective patients undergoing minimally invasive lumbar fusion at a single academic institution. Objective: To assess differences in perioperative outcomes between primary and revision MIS (minimally invasive surgical) lumbar interbody fusion patients and compare with those undergoing corresponding open procedures. Methods: Patients ≥18 years old undergoing lumbar interbody fusion were grouped by surgical technique: MIS or open. Patients within each group were propensity score matched for comorbidities and levels fused. Patient demographics, surgical factors, and perioperative complication incidences were compared between primary and revision cases using means comparison tests, as appropriate. Results: Of the 214 lumbar interbody fusion patients included after propensity score matching, 44 (21%) cases were MIS, and 170 (79%) were open. For MIS patients, there were no significant differences between primary and revision cases in estimated blood loss (EBL; 344 vs 299 cm3, P = .682); however, primary cases had longer operative times (301 vs 246 minutes, P = .029). There were no differences in length of stay (LOS), intensive care unit LOS, readmission, and intraoperative or postoperative complications (all P > .05). For open patients, there were no differences between primary and revision cases in EBL ( P > .05), although revisions had longer operative times (331 vs 278 minutes, P = .018) and more postoperative complications (61.7% vs 23.8%, P < .001). MIS revision procedures were shorter than open revisions (182 vs 213 minutes, P = .197) with significantly less EBL (294 vs 965 cm3, P < .001), shorter inpatient and intensive care unit LOS, and fewer postoperative complications (all P < .05). Conclusions: Clinical outcomes of revision MIS lumbar interbody fusion were similar to those of primary surgery. Additionally, MIS techniques were associated with less EBL, shorter LOS, and fewer perioperative complications than corresponding open revisions.

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Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit

The American Surgeon ◽

10.1177/000313481408000827 ◽

2014 ◽

Vol 80 (8) ◽

pp. 778-782 ◽

Cited By ~ 2

Author(s):

A. Britton Christmas ◽

Elizabeth Freeman ◽

Angela Chisolm ◽

Peter E. Fischer ◽

Gaurav Sachdev ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Brain Injuries ◽

Injury Severity ◽

Hospital Costs ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Respiratory Compromise ◽

Patient Demographics ◽

Hygiene Practices

Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

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Cost Savings Associated with Palliative Care (DRAFT)

10.1093/med/9780190658618.003.0007 ◽

2018 ◽

Author(s):

Breffni Hannon

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Diagnostic Imaging ◽

Hospital Costs ◽

Cost Savings ◽

Direct Costs ◽

Economic Benefits ◽

Propensity Scoring ◽

Clinical Benefits

Although the clinical benefits associated with hospital-based palliative care (PC) consultation teams are well established, few studies address the potential economic impact of these services. This study aimed to examine the effect of hospital-based PC teams on hospital costs for patients who died in the hospital, as well as for those discharged alive. Eight diverse hospital settings with established PC teams were chosen, and administrative data relating to direct costs (including laboratory, diagnostic imaging, pharmacy, and intensive care unit [ICU] costs) were analyzed. Propensity scoring was used to match PC patients with usual care (UC) patients. Of 2,630 PC patients who were discharged alive, net savings of $2,642 per admission were calculated, compared with 18,427 UC patients. For the 2,278 PC patients who died in the hospital, savings of $4,908 per admission were seen, when compared with 2,124 UC patients, confirming the additional economic benefits associated with hospital-based PC teams.

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Selective Intensive Care Unit Admission After Adult Supratentorial Tumor Craniotomy: Complications, Length of Stay, and Costs

Neurosurgery ◽

10.1093/neuros/nyz388 ◽

2019 ◽

Vol 86 (1) ◽

pp. E54-E59 ◽

Cited By ~ 5

Author(s):

Mark ter Laan ◽

Suzanne Roelofs ◽

Ineke Van Huet ◽

Eddy M M Adang ◽

Ronald H M A Bartels

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Cost Reduction ◽

Hospital Costs ◽

Qualitative Evaluation ◽

Complication Rates ◽

Supratentorial Tumor ◽

Before And After ◽

Supratentorial Tumors

Abstract BACKGROUND Admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice even though some studies have suggested lower level care is sufficient for selected patients. We have introduced a “no ICU, unless” policy for tumor craniotomy patients. OBJECTIVE To provide a quieter postoperative environment for patients, reduce the burden on the ICU department, and to evaluate whether costs can be reduced. METHODS A cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 1 yr after introduction (n = 109) of the new policy with the year before (n = 107). Rate of complications was evaluated, as was the length of stay and patient satisfaction using qualitative evaluation. Finally, costs were evaluated comparing the situation before and after implementation of the new protocol. RESULTS A reduction in ICU/MCU admittance from 64% to 24% of patients was found resulting in 13.3% cost reduction (€1950 per case), without increasing the length of stay at the ward. The length of stay in the hospital was similar. Complications were significantly reduced after implementing the new policy (0.98 vs 0.53 per patient, P = .003). Patients that were interviewed after the new policy reported feeling safe and at ease at the ward. CONCLUSION Changing our policy from “ICU, unless” to “no ICU, unless” reduced complication rates and length of stay in the hospital while keeping patients satisfied. Hospital costs related to the admission have been significantly reduced by the new policy.

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The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n9p104 ◽

2019 ◽

Vol 9 (9) ◽

pp. 104

Author(s):

Fabiola Alves Gomes ◽

Denise Von Dolinger de Brito Röder ◽

Thúlio Marquez Cunha ◽

Rosângela De Oliveira Felice ◽

Guilherme Silva Mendonça ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Costs ◽

University Hospital ◽

Nursing Workload ◽

Ventilator Associated Pneumonia ◽

Adult Intensive Care Unit ◽

Icu Admission ◽

Stay Time ◽

The Impact

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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A Minimally Invasive Device for Continuous Glucose Monitoring in Infants

Journal of Medical Devices ◽

10.1115/1.2936212 ◽

2008 ◽

Vol 2 (2) ◽

Cited By ~ 3

Author(s):

Christopher P. Erdman ◽

Stephen M. Goldman ◽

Patrick J. Lynn ◽

Matthew C. Ward

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Minimally Invasive ◽

Neonatal Intensive Care Unit ◽

Continuous Glucose Monitoring ◽

Neonatal Intensive Care ◽

Glucose Monitoring ◽

Polarized Light ◽

Invasive Device ◽

Minimally Invasive Device

Blood sugar management is particularly critical in the neonatal intensive care unit where the incidence of hypoglycemia is high and patients run the risk of brain damage. The staff at most hospitals obtain glucose levels in infants by drawing blood from the heel, which is a cause for recurrent pain. Some infants undergo this procedure every 1–3hours for up to a few months. Our goal is to design a minimally invasive device that allows for real-time glucose monitoring in very low birth weight infants in the neonatal intensive care unit (NICU). This glucose monitor will reduce the amount of pain and physiological stress on the infants, decrease the risk of hypoglycemia in neonates and reduce the workload on hospital staff. There is currently much room for emerging technologies in this market as it trends towards less pain and faster responses. The device should only slightly hinder the infant’s motion, be as painless as possible, and all materials used in contact with the body need to be biologically inert and cause no irritation or allergic reaction. The device will utilize a microneedle array to extract interstitial fluid and draw it through a hydrophilic polyurethane membrane and into a polarimetry chamber. Circularly polarized light will be passed through the chamber and the differential absorbance of left and right polarized light will be used to calculate the glucose concentration. A literature and patent review showed that each separate portion could be used in an effective device for minimally invasive, continuous glucose monitoring.

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Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

Neurosurgical FOCUS ◽

10.3171/2015.5.focus15129 ◽

2015 ◽

Vol 39 (2) ◽

pp. E11 ◽

Cited By ~ 31

Author(s):

Albert P. Wong ◽

Rishi R. Lall ◽

Nader S. Dahdaleh ◽

Cort D. Lawton ◽

Zachary A. Smith ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Open Group ◽

Perioperative Outcomes ◽

Open Approach ◽

Open Resection ◽

Spine Tumors ◽

Intradural Extramedullary

OBJECT Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS. METHODS A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups. RESULTS Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81). The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05). CONCLUSIONS Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.

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