Elective surgical cases generally have lower costs, higher profit margins, and better outcomes than nonelective cases. Investigating the differences in cost and profit between elective and nonelective cases would help hospitals in planning strategies to withstand financial losses due to potential pandemics. The authors sought to evaluate the exact cost and profit margin differences between elective and nonelective supratentorial tumor resections at a single institution.
The authors collected economic analysis data in all patients who underwent supratentorial tumor resection at their institution between January 2014 and December 2018. The patients were grouped into elective and nonelective cases. Propensity score matching was used to adjust for heterogeneity of baseline characteristics between the two groups.
There were 143 elective cases and 232 nonelective cases over the 5 years. Patients in the majority of elective cases had private insurance and in the majority of nonelective cases the patients had Medicare/Medicaid (p < 0.01). The total charges were significantly lower for elective cases ($168,800.12) compared to nonelective cases ($254,839.30, p < 0.01). The profit margins were almost 6 times higher for elective than for nonelective cases ($13,025.28 vs $2,128.01, p = 0.04). After propensity score matching, there was still a significant difference between total charges and total cost.
Elective supratentorial tumor resections were associated with significantly lower costs with shorter lengths of stay while also being roughly 6 times more profitable than nonelective cases. These findings may help future planning for hospital strategies to survive financial losses during future pandemics that require widespread cancellation of elective cases.
von ElmE, AltmanDG, EggerM, et al.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–1499.
von ElmE, AltmanDG, EggerM, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–1499.10.1016/j.ijsu.2014.07.01325046131)| false
FineMJ, PrattHM, ObroskyDS, Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med. 2000;109(5):378–385.1102039410.1016/S0002-9343(00)00500-3)| false
SafaeeMM, MorshedRA, SpatzJ, et al.Interfacility neurosurgical transfers: an analysis of nontraumatic inpatient and emergency department transfers with implications for improvements in care. J Neurosurg. 2018;131(1):281–289.
SafaeeMM, MorshedRA, SpatzJ, Interfacility neurosurgical transfers: an analysis of nontraumatic inpatient and emergency department transfers with implications for improvements in care. J Neurosurg. 2018;131(1):281–289.10.3171/2018.3.JNS17322430074453)| false
LopezE, NeumanT, JacobsonG, LevittL. How much more than Medicare do private insurers pay? A review of the literature. Kaiser Family Foundation. Accessed January 27, 2021. https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/)| false
HammersR, AnzaloneS, SinacoreJ, OrigitanoTC. Neurosurgical mortality rates: what variables affect mortality within a single institution and within a national database?J Neurosurg. 2010;112(2):257–264.1964553710.3171/2009.6.JNS081235)| false
LaanMT, RoelofsS, Van HuetI, Selective intensive care unit admission after adult supratentorial tumor craniotomy: complications, length of stay, and costs. Neurosurgery. 2020;86(1):E54–E59.3154124310.1093/neuros/nyz388)| false
YoungJS, ChanAK, VinerJA, et al.A Safe Transitions Pathway for post-craniotomy neurological surgery patients: high-value care that bypasses the intensive care unit. J Neurosurg. Published online January 27, 2021. doi: https://doi.org/10.3171/2020.3.JNS192133
YoungJS, ChanAK, VinerJA, A Safe Transitions Pathway for post-craniotomy neurological surgery patients: high-value care that bypasses the intensive care unit. J Neurosurg. Published online January 27, 2021. doi: https://doi.org/10.3171/2020.3.JNS19213332470928)| false
OsorioJA, SafaeeMM, VinerJ, Cost-effectiveness development for the postoperative care of craniotomy patients: a safe transitions pathway in neurological surgery. Neurosurg Focus. 2018;44(5):E19.2971252910.3171/2018.2.FOCUS1812)| false