Clinical utility and cost analysis of routine postoperative head CT in elective aneurysm clippings

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  • 1 Departments of Neurological Surgery and
  • 2 Radiology, University of California, San Francisco, California
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OBJECTIVE

Postoperative head CT scanning is performed routinely at the authors' institution on all neurosurgical patients after elective aneurysm clippings. The goal of this study was to determine how often these scans influence medical management and to quantify the associated imaging costs.

METHODS

The authors reviewed the medical records and accounting database of 304 patients who underwent elective (i.e., nonruptured) aneurysm clipping performed by 1 surgeon (M.T.L.) from 2010 to 2014 at the University of California, San Francisco. Specifically, the total number of postoperative head CT scans, radiographic findings, and the effect of these studies on patient management were determined. The authors obtained the total hospital costs for these patients, including the cost of imaging studies, from the hospital accounting database.

RESULTS

Overall, postoperative CT findings influenced clinical management in 3.6% of cases; specifically, they led to permissive hypertension in 4 patients for possible ischemia, administration of mannitol for edema and high-flow oxygen for pneumocephalus in 2 patients each, seizure prophylaxis in 1 patient, Plavix readjustment in 1 patient, and return to the operating room for an asymptomatic epidural hematoma evacuation in 1 patient. When patients were stratified on the basis of postoperative neurological examination, findings on CT scans altered management in 1.1%, 4.8%, and 9.0% of patients with no new neurological deficits, a nonfocal examination, and focal deficits, respectively. The mean total hospital cost for treating patients who undergo elective aneurysm clipping was $72,227 (± $53,966) (all values are US dollars), and the cost of obtaining a noncontrast head CT scan was $292. Neurologically intact patients required 99 head CT scans, at a cost of $28,908, to obtain 1 head CT scan that influenced medical management. In contrast, patients with a focal neurological deficit required only 11 head CT scans, at a cost of $3212, to obtain 1 head CT scan that changed clinical management.

CONCLUSIONS

Although there are no clear guidelines, the large number and high cost of CT scans needed to treat neurologically intact elective aneurysm patients suggest that careful neurological monitoring may be more clinically useful and a better use of hospital resources than routine postoperative CT.

ABBREVIATIONSCTPA = CT pulmonary angiography; ICU = intensive care unit; mSv = milliseivert; OR = operating room; UCSF = University of California, San Francisco.

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Contributor Notes

INCLUDE WHEN CITING Published online April 29, 2016; DOI: 10.3171/2016.1.JNS152242.

Correspondence Michael Lawton, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Rm. M779, San Francisco, CA 94143. email: lawtonm@neurosurg.ucsf.edu.
  • 1

    Allen C, Seinge R, Maxwell R, Thind D: CT pulmonary angiography and pulmonary embolism following 5809 primary joint arthroplasties. N Z Med J 128:4149, 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Almenawer SA, Bogza I, Yarascavitch B, Sne N, Farrokhyar F, Murty N, : The value of scheduled repeat cranial computed tomography after mild head injury: single-center series and meta-analysis. Neurosurgery 72:5664, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Berrington de González A, Darby S: Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345351, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Brenner DJ: Should we be concerned about the rapid increase in CT usage?. Rev Environ Health 25:6368, 2010

  • 5

    Brown CV, Weng J, Oh D, Salim A, Kasotakis G, Demetriades D, : Does routine serial computed tomography of the head influence management of traumatic brain injury? A prospective evaluation. J Trauma 57:939943, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Costa AF, Basseri H, Sheikh A, Stiell I, Dennie C: The yield of CT pulmonary angiograms to exclude acute pulmonary embolism. Emerg Radiol 21:133141, 2014

  • 7

    CostEvaluation.com: How much does a CT scan cost?. (http://www.costevaluation.com/ct-scan-cost.php) [Accessed online February 24, 2016]

    • Export Citation
  • 8

    Durham SR, Liu KC, Selden NR: Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg 105:5 Suppl 365369, 2006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Fontes RB, Smith AP, Muñoz LF, Byrne RW, Traynelis VC: Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center. J Neurosurg 121:307312, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Garrett MC, Bilgin-Freiert A, Bartels C, Everson R, Afsarmanesh N, Pouratian N: An evidence-based approach to the efficient use of computed tomography imaging in the neurosurgical patient. Neurosurgery 73:209216, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Hanak BW, Walcott BP, Nahed BV, Muzikansky A, Mian MK, Kimberly WT, : Postoperative intensive care unit requirements after elective craniotomy. World Neurosurg 81:165172, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Hutchinson BD, Navin P, Marom EM, Truong MT, Bruzzi JF: Overdiagnosis of pulmonary embolism by pulmonary CT angiography. AJR Am J Roentgenol 205:271277, 2015

  • 13

    Kaups KL, Davis JW, Parks SN: Routinely repeated computed tomography after blunt head trauma: does it benefit patients?. J Trauma 56:475481, 2004

  • 14

    Klassen TP, Reed MH, Stiell IG, Nijssen-Jordan C, Tenenbein M, Joubert G, : Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience. Acad Emerg Med 7:739744, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Prevedello LM, Raja AS, Zane RD, Sodickson A, Lipsitz S, Schneider L, : Variation in use of head computed tomography by emergency physicians. Am J Med 125:356364, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Schunk JE, Rodgerson JD, Woodward GA: The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care 12:160165, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Sifri ZC, Homnick AT, Vaynman A, Lavery R, Liao W, Mohr A, : A prospective evaluation of the value of repeat cranial computed tomography in patients with minimal head injury and an intracranial bleed. J Trauma 61:862867, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Sifri ZC, Livingston DH, Lavery RF, Homnick AT, Mosenthal AC, Mohr AM, : Value of repeat cranial computed axial tomography scanning in patients with minimal head injury. Am J Surg 187:338342, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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