Fe374e73 c7e1 11de 826900219b8d5584E PPD was used to establish the costs of CSFleaks following spinal surgery using ICD-9 and CPTcodes for spinal procedures discharged between Q42006 and Q3 2008.Specically, ICD-9 procedurecodes used were for CSF repairs while ICD-9diagnosis codes were used for dural tears and CSFleaks.CPT codes for spinal procedures were alsoincluded.
PPD is the largest clinical and economicdatabase developed for quality and utilizationbenchmarking including one in every ve USAhospital discharges.
e major direct medical costsassessed included length of hospital stay, laboratorycosts, pharmacy costs, and central hospital supply.Demographic Comparisons: Patients with CSF Leaks
Compared to No CSF LeaksCost of CSF Leaks by Major Cost CategoryIntroductione establishment of a watertight closure of the dura mater following spinal surgery is critical as post operative cerebral spinal uid (CSF) leaks may cause medical complications, increased length of hospital stay, reduced quality of life, and added costs.
Neurosurgeries in the infratentorial and spinal regions have a greater risk for CSF leaks than procedures in the supratentorial region likely due to increased hydrostatic pressure associated with gravity when patients are sitting upright.(1)Previous research with brin glue, as an adjunct tosutured closure, has found post-operative CSF leakrates in the spinal region as high as 24%.(1) Our study assessed the added cost of CSF leaks following spinal surgery through Premiers Perspective Database (PPD) as little information is available on the direct medical costs associated with CSF leaks aer spinal surgery.Patient Characteristics of Spinal Surgery Patientswith and without CSF LeaksTable 1 provides basic demographic comparisons ofspinal surgery patients who had CSF leaks compared to those who did not have a CSF leak.Oklahoma Spine & Brain Institute, Tulsa, OK, USA (Baird); Premier Inc., Charlotte, NC, USA (Ernst); Covidien, NorthHaven, CT, USA ( fluid (CSF) leak is a significant causeof morbidity following cranial surgery.CSF leaks cancause secondary surgical complications includingmeningitis, encephalitis, pneumocephalus, andchronic subdural hematoma often leading to addedcosts.(1) A comparative published study reportedCSF leak rates in posterior fossa procedures of 2%using a polyethylene glycol (PEG) hydrogel duralsealant in a 100 patient prospective group, and aCSF leak rate of 10% using fibrin sealant in a 100patient retrospective, cohort group.(2) Our studyapplied the cost of CSF leaks following cranialsurgery using the Premier Perspective Database(PPD).PPD is the largest clinical and economicdatabase developed for quality and utilizationbenchmarking covering one in every five USAhospital discharges
.MethodsThe PPD was used to establish the costs of CSFleaks following cranial surgery using ICD-9 and CPTcodes for cranial procedures discharged between Q42006 and Q3 2008.Specifically, ICD-9 procedurecodes used were for CSF repairs while ICD-9diagnosis codes were used for dural tears and CSFleaks.
Postoperative Cerebrospinal Fluid Leaks Of The Lumbosacral Spine ...
follow-up surgery repaired an unsuspected dural tear just distal to the site of original ... spinal fluid fistula treated with an epidural blood patch. Spine 1994; ... (utsouthwestern.edu)
Persistent Cerebrospinal Fluid Leak: A Complication Of The ...
fluid (CSF) leak after combined spinal- ... was when she reported a “wet back” 2 days after surgery. Fifty milliliters of clear fluid had collected under the epi- (orlive.com)
CPT codes for cranial procedures were alsoincluded.We then compared potential hospital costoffsets using a PEG hydrogel sealant ($620 pertreatment, 5 ml size, Company List Price, Covidien,Waltham, MA) with fibrin sealant ($225 pertreatment, 4 ml size, Company List Price, Baxter,Deerfield, IL) assuming CSF leak rates of 2% and10% for posterior fossa procedures only.(2)ResultsCharacteristics of Cranial Surgery Patients with andwithout CSF LeaksTable 1 provides basic demographic comparisons ofcranial surgery patients who had CSF leakscompared to those who did not have a CSF leak.Table 1: Demographic Comparisons: Patientswith CSF Leaks Compared to No CSF LeaksCost of CSF Leaks in Cranial SurgeryTable 2 describes the breakdown in costs by majorhospital cost category for cranial surgery patientswith CSF leaks compared to those who did not havea CSF leak.Table 2.Cost of CSF Leaks by Major CostCategoryNote: Summing the cost categories may not add up to the totalcost since each subgroup may have smaller population sizes.We found the average cost of cranial surgeries withCSF leaks (n=1,192) to be $49,132compared with $32,637$38,677 (p0.0001) forcranial surgeries without CSF leaks (n=16,587).Thecost difference was largely driven by increasedlength of hospital (3.4 days) and intensive carestays (2.7 days) for cranial surgery patients withCSF leaks (both p0.0001).The PPD analysisshowed that all cost categories increased in astatistically significant manner when comparingcranial surgery patients with a CSF leak to thosewithout a CSF leak.Cost Analysis using a PEG Hydrogel SealantCompared with Fibrin Sealant in Posterior FossaWe performed a hypothetical analysis for a hospitalthat performed 100 posterior fossa procedures usinga PEG hydrogel sealant on all 100 patients comparedwith fibrin sealant on all 100 patients.The expectedCSF leak rate for posterior fossa surgery was 2%using PEG hydrogel sealant (2/100) and 10% forfibrin sealant (10/100) based on the comparativestudy.(2) We then assumed a cost of $16,495 perCSF leak, from the PPD analysis, and $620 pertreatment for a PEG hydrogel sealant compared with$225 per treatment for fibrin sealant applied to all100 procedures for each option.
These calculationsare summarized in Table 3.Table 3.Total Costs for 100 Posterior FossaProcedures using a PEG Hydrogel SealantCompared with Fibrin Sealant*CSF leak rates reported in posterior fossa procedures.(2)ConclusionsUse of a PEG hydrogel sealant compared with fibrinsealant could potentially save $92,460 for a hospitalthat performed 100 posterior fossa procedures usinga PEG hydrogel sealant compared with using fibrinsealant on all 100 procedures.This studydemonstrates the economic advantages of using aPEG hydrogel sealant in posterior fossa procedures.Future studies would be beneficial to confirm thesefindings and understand the possible economicadvantages for other types of cr
Tags: post-surgery spinal fluid leaks,cerebral spinal fluid leakage,fluid on spine after surgery,csf leak after surgery,