Use of tissue glues in endoscopic pituitary surgery: a cost comparison.

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®.

Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases.

BACKGROUND: Cerebrospinal fluid (CSF) leaks are widely recognized as commonly occurring postoperative complications of neurosurgical procedures. We will focus on the direct costs associated with CSF leaks in a single center across multiple neurosurgical procedures, based on a retrospective analysis. We will also compare the costs of using a synthetic agent to prevent such leaks with these costs from a more recent study. METHODS: The single-center retrospective study was carried out at the Neurosurgical Center Nijmegen (University Medical Center St Radboud and Canisius Wilhelmina Hospital, Nijmegen, Netherlands) from January 01, 1999, until December 31, 1999. Four hundred twelve consecutive, nontrauma, elective procedures were examined. RESULTS: By applying strict criteria for CSF leakage (including those self-limiting subcutaneous minor CSF collection), we found an overall leak rate of 10.7% with a lower number for supratentorial and transsphenoidal procedures and much higher numbers for infratentorial procedures and extensive skull base procedures (6 [12.8%] of 47 and 18 [34.6%] of 52, respectively). The CSF leak in these 44 patients was associated with high additional costs which accounted for 21.7% of the total costs of all 412 procedures or on average 1508 per patient and procedure. If DuraSeal (Confluent Surgical, Inc, Waltham, MA) were to be used prophylactically for every procedure, and assuming a 4% leak rate postprocedure (which was achieved in a more recent study of 46 patients using DuraSeal), there would be a saving of 550 for every procedure (reduction in additional costs of CSF leak minus the cost of the sealant), or a total saving of 226600 in the series of 412 patients. CONCLUSION: Our analysis establishes that CSF leaks occur with high frequency and incur significant costs across all types of surgical procedures. A direct correlation of this complication (and ensuring costs) is observed with more extensive procedures, and reduction of these significant costs can be achieved by using augmentation of the dural closure with DuraSeal.