The Cost of Brain Surgery: Awake vs Asleep Craniotomy for Perirolandic Region Tumors

Chikezie I. Eseonu, Jordina Rincon-Torroella, Karim Refaey, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Cost effectiveness has become an important factor in the health care system, requiring surgeons to improve efficacy of procedures while reducing costs. An awake craniotomy (AC) with direct cortical stimulation (DCS) presents one method to resect eloquent region tumors; however, some authors assert that this procedure is an expensive alternative to surgery under general anesthesia (GA) with neuromonitoring. OBJECTIVE: To evaluate the cost effectiveness and clinical outcomes between AC and GA patients. METHODS: Retrospective analysis of a cohort of 17 patients with perirolandic gliomas who underwent an AC with DCS were case-control matched with 23 patients with perirolandic gliomas who underwent surgery under GA with neuromonitoring (ie, motor-evoked potentials, somatosensory-evoked potentials, phase reversal). Inpatient costs, quality-adjusted life years (QALY), extent of resection, and neurological outcome were compared between the groups. RESULTS: Total inpatient expense per patient was $34 804 in the AC group and $46 798 in the GA group (P =.046). QALY score for the AC group was 0.97 and 0.47 for the GA group (P =.041). The incremental cost per QALY for the AC group was $82 720 less than the GA group. Postoperative Karnofsky performance status was 91.8 in the AC group and 81.3 in the GA group (P =.047). Length of hospitalization was 4.12 days in the AC group and 7.61 days in the GA group (P =.049). CONCLUSION: The total inpatient costs for awake craniotomies were lower than surgery under GA. This study suggests better cost effectiveness and neurological outcome with awake craniotomies for perirolandic gliomas.

Original languageEnglish (US)
Pages (from-to)307-314
Number of pages8
JournalNeurosurgery
Volume81
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Craniotomy
General Anesthesia
Costs and Cost Analysis
Brain
Neoplasms
Quality-Adjusted Life Years
Glioma
Cost-Benefit Analysis
Inpatients
Karnofsky Performance Status
Motor Evoked Potentials
Somatosensory Evoked Potentials
Hospitalization
Cohort Studies
Delivery of Health Care

Keywords

  • Awake craniotomy
  • Cost
  • Direct cortical stimulation
  • Glioma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Cost of Brain Surgery : Awake vs Asleep Craniotomy for Perirolandic Region Tumors. / Eseonu, Chikezie I.; Rincon-Torroella, Jordina; Refaey, Karim; Quinones-Hinojosa, Alfredo.

In: Neurosurgery, Vol. 81, No. 2, 01.08.2017, p. 307-314.

Research output: Contribution to journalArticle

Eseonu, Chikezie I. ; Rincon-Torroella, Jordina ; Refaey, Karim ; Quinones-Hinojosa, Alfredo. / The Cost of Brain Surgery : Awake vs Asleep Craniotomy for Perirolandic Region Tumors. In: Neurosurgery. 2017 ; Vol. 81, No. 2. pp. 307-314.
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