Elective versus nonelective brain tumor resections: a 5-year propensity score matching cost comparison analysis

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  • 1 Departments of Neurological Surgery and
  • | 2 Anesthesiology, University of California, Irvine, California
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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS

LOS = length of stay; ROM = risk of mortality.

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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  • 1

    Haider AH, Obirieze A, Velopulos CG, et al. Incremental cost of emergency versus elective surgery. Ann Surg. 2015;262(2):260266.

  • 2

    Farrero M, Flores-Umanzor EJ, Pomar JL, et al. Elective or emergency heart transplantation: cost comparison in a single center. Clin Transplant. 2019;33(7):e13596.

  • 3

    Matheny J, Toner E, Waldhorn R. Financial effects of an influenza pandemic on US hospitals. J Health Care Finance. 2007;34(1):5863.

  • 4

    Husereau D, Drummond M, Petrou S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ. 2013;346:f1049.

  • 5

    von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):14951499.

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

    Stuart EA, King G, Imai K, Ho D. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw. 2011;42(8):128.

  • 7

    Fine MJ, Pratt HM, Obrosky DS, et al. Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med. 2000;109(5):378385.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Safaee MM, Morshed RA, Spatz J, 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):281289.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Anis HK, Sodhi N, Coste M, et al. A comparison of peri-operative outcomes between elective and non-elective total hip arthroplasties. Ann Transl Med. 2019;7(4):78.

  • 10

    Baker LC, Bundorf MK, Devlin AM, Kessler DP. Medicare Advantage plans pay hospitals less than traditional Medicare pays. Health Aff (Millwood). 2016;35(8):14441451.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Biener AI, Selden TM. Public and private payments for physician office visits. Health Aff (Millwood). 2017;36(12):21602164.

  • 12

    Cooper Z, Craig SV, Gaynor M, Van Reenen J. The price ain’t right? Hospital prices and health spending on the privately insured. Q J Econ. 2019;134(1):51107.

  • 13

    Lopez E, Neuman T, Jacobson G, Levitt L. 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/

    • Search Google Scholar
    • Export Citation
  • 14

    Hammers R, Anzalone S, Sinacore J, Origitano TC. Neurosurgical mortality rates: what variables affect mortality within a single institution and within a national database? J Neurosurg. 2010;112(2):257264.

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

    Siqueira EMP, Diccini S. Postoperative complications in elective and non-elective neurosurgery. Acta Paul Enferm. 2017;30(1):101108.

  • 16

    Zygourakis CC, Liu CY, Yoon S, et al. Analysis of cost variation in craniotomy for tumor using 2 national databases. Neurosurgery. 2017;81(6):972979.

  • 17

    Laan MT, Roelofs S, Van Huet I, et al. Selective intensive care unit admission after adult supratentorial tumor craniotomy: complications, length of stay, and costs. Neurosurgery. 2020;86(1):E54E59.

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

    Young JS, Chan AK, Viner JA, 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

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Osorio JA, Safaee MM, Viner J, et al. Cost-effectiveness development for the postoperative care of craniotomy patients: a safe transitions pathway in neurological surgery. Neurosurg Focus. 2018;44(5):E19.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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