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

Published online by Cambridge University Press:  02 December 2014

Lukas H. Kus
Affiliation:
School of Medicine, Queen's University, Kingston
Brian W. Rotenberg
Affiliation:
Department of Otolaryngology - Head & Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
Neil Duggal
Affiliation:
Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
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Abstract

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®.

Résumé:

RÉSUMÉ: Contexte:

Les fuites postchirurgicales de liquide céphalo–rachidien sont une complication fréquente de la chirurgie pituitaire endoscopique et génèrent une portion importante des coûts hospitaliers associés à cette intervention. Tisseel est une colle à tissus qui est utilisée fréquemment comme traitement d’appoint pour la réparation durale, mais ne constitue pas une solution optimale dans cette situation. La colle DuraSeal possède plusieurs propriétés avantageuse pour la réparation durale, mais elle n’est pas largement utilisée au Canada, en partie parce que son coût est plus élevé.

Objectif:

Le but de l’étude était de comparer le coût de la colle DuraSeal et de la colle Tisseel lors de la chirurgie pituitaire endoscopique.

Méthodes:

Une analyse des coûts a été effectuée basée sur des cas de chirurgie pituitaire endoscopique opérés dans notre institution de soins tertiaires. Nous avons déterminé directement les coûts pour la salle d’opération, l’hospitalisation et le scellant chirurgical et nous avons estimé le temps de guérison et le taux de fuites postopératoires de LCR à partir de valeurs consensus rapportées dans la littérature. Nous rapportons les résultats pour différents scénarios cliniques possibles d’utilisation du scellant.

Résultats:

Dans un modèle où le scellent chirurgical est utilisé uniquement chez les cas à haut risque, l’utilisation du DuraSeal permet d’épargner au moins $4486,72. Si le scellent chirurgical est utilisé chez tous les cas, l’utilisation régulière de DuraSeal plutôt que de Tisseel réduit peu les coûts annuels ou les augmente de $7619,25 au maximum, selon le volume de cas et le taux estimé de fuites postopératoires de LCR.

Conclusion:

Dans la plupart des scénarios cliniques, l’utilisation de DuraSeal pour la chirurgie pituitaire endoscopique peut réduire les coûts hospitaliers annuels totaux par rapport au Tisseel.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2010

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