. 11 demonstrated that patients with severe TBI and refractory raised ICP who underwent decompressive craniectomy had worse functional outcome than patients who did not receive aggressive therapy. With the uncertainty surrounding aggressive management of TBI and the high costs of such treatment, it is unclear whether invasive intracranial monitoring and decompressive craniectomy are cost-effective interventions. The purpose of this study is to determine whether aggressive treatment of severe TBI is cost-effective compared with less aggressive–treatment strategies
Robert G. Whitmore, Jayesh P. Thawani, M. Sean Grady, Joshua M. Levine, Matthew R. Sanborn, and Sherman C. Stein
Nathan Todnem, Khoi D. Nguyen, Vamsi Reddy, Dayton Grogan, Taylor Waitt, and Cargill H. Alleyne Jr.
model is not only inexpensive (less than $5 per mold), but each mold can be used 20–30 times, and the skull base can be reused indefinitely to make more molds. We present a novel, yet simple, and cost-effective technique for developing a brain model constructed of homemade ballistics gelatin that can be used for teaching and practicing the placement of EVDs. Method Brain Model Construction An anatomically correct skull model (hardened plastic) was separated in the midsagittal plane to create the base for the molds ( Fig. 1 ). A 3D-printed ventricular model was
Corinna C. Zygourakis, Taemin Oh, Matthew Z. Sun, Igor Barani, James G. Kahn, and Andrew T. Parsa
radiation ($15,714). The highest QALY is associated with surgery (23.30), followed by radiation (22.81) and then observation (21.40). Radiation is therefore a dominant treatment to observation, in that it is both cheaper in the long term (lower cost) and produces better outcomes (higher QALY). Table 4 also demonstrates that surgery is a cost-effective treatment as compared with radiation, with an ICER of $137,747. In the US, ICERs < $150,000 are typically considered cost-effective, because this represents 3 times our gross domestic product per capita ( www
Michael G. Fehlings, Neilank K. Jha, Stephanie M. Hewson, Eric M. Massicotte, Branko Kopjar, and Sukhvinder Kalsi-Ryan
, based on a 20% variation in utility values. Discussion Our analysis suggests that surgical treatment for CSM is a cost-effective intervention by conventional standards. The cost-utility ratio for CSM surgeries is CaD $32,916/QALY, which is below WHO benchmarks that suggest that programs be considered highly cost-effective if life years are purchased at a cost of less than gross domestic product per capita, which was US $45,110 (CaD $46,012 by midyear exchange rate in 2008). 36 Table 4 lists the cost utility of other accepted surgeries, indicating that the
Hardik Sardana, Madhur Kaura, and Shweta Kedia
incorrect to assume that a low Wells score and a low D-dimer level would be uncommon in the patients included in their study. We believe that many preoperative cases of brain tumor have a low Wells score and can rule out DVT in a significant portion of the cases. Additional investigation using Doppler ultrasound would not be cost-effective in all the cases. A young, neurologically intact patient without any known medical comorbidities diagnosed with low-grade glioma would have a low Wells score and does not, in our opinion, warrant additional Doppler ultrasonography. The
Susan R. Snyder
% spinal pathologies) to two nodal centers located in the Indian cities of Barrackpore, West Bengal, and Bhubaneshwar, Odisha. This descriptive study retrospectively analyzed clinical data from more than 1500 patients with over 3000 teleconsultations during a 6-year period beginning in 2007. Based on their results, the authors concluded that videoconferencing for neurosurgical procedure follow-up care was efficient, safe, and cost-effective in an environment with significant resource constraints. New Neurosurgery Telemedicine Follow-Up Care Cost-Effectiveness Study A new
Ebru Tarıkçı Kılıç, Tuncay Demirbilek, and Sait Naderi
significantly shorter length of hospital stay. This result can be explained by 2 factors: shorter operative time and better pain management. We used institutional accounting data for cost analysis. Our results supported the evidence that ERAS not only provides preoperative benefits but also decreases healthcare costs. The current analysis included assessment of anesthetic and surgery costs and, as expected, ERAS was found to be cost-effective. Randomized controlled trials with the intention of evaluating all associated costs are needed to comprehensively assess the benefits
Yuichiro Abe, Manabu Ito, Kuniyoshi Abumi, Yoshihisa Kotani, Hideki Sudo, and Akio Minami
Use of computer-assisted spine surgery (CASS) technologies, such as navigation systems, to improve the accuracy of pedicle screw (PS) placement is increasingly popular. Despite of their benefits, previous CASS systems are too expensive to be ubiquitously employed, and more affordable and portable systems are desirable. The aim of this study was to introduce a novel and affordable computer-assisted technique that 3-dimensionally visualizes anatomical features of the pedicles and assists in PS insertion. The authors have termed this the 3D-visual guidance technique for inserting pedicle screws (3D-VG TIPS).
The 3D-VG technique for placing PSs requires only a consumer-class computer with an inexpensive 3D DICOM viewer; other special equipment is unnecessary. Preoperative CT data of the spine were collected for each patient using the 3D-VG TIPS. In this technique, the anatomical axis of each pedicle can be analyzed by volume-rendered 3D models, as with existing navigation systems, and both the ideal entry point and the trajectory of each PS can be visualized on the surface of 3D-rendered images. Intraoperative guidance slides are made from these images and displayed on a TV monitor in the operating room. The surgeon can insert PSs according to these guidance slides. The authors enrolled 30 patients with adolescent idiopathic scoliosis (AIS) who underwent posterior fusion with segmental screw fixation for validation of this technique.
The novel technique allowed surgeons, from office or home, to evaluate the precise anatomy of each pedicle and the risks of screw misplacement, and to perform 3D preoperative planning for screw placement on their own computer. Looking at both 3D guidance images on a TV monitor and the bony structures of the posterior elements in each patient in the operating theater, surgeons were able to determine the best entry point for each PS with ease and confidence. Using the current technique, the screw malposition rate was 4.5% in the thoracic region in corrective surgery for AIS.
The authors found that 3D-VG TIPS worked on a consumer-class computer and easily visualized the ideal entry point and trajectory of PSs in any operating theater without costly special equipment. This new technique is suitable for preoperative planning and intraoperative guidance when performing reconstructive surgery with PSs.
Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Nicholas Theodore, and Daniel M. Sciubba
I n an effort to reduce variability, improve outcomes, and reduce cost in spinal surgery, there has been a recent drive to identify care pathways that result in consistently good, cost-effective outcomes for patients. This drive has led to the development of Enhanced Recovery After Surgery (ERAS) pathways, which were first described as “fast-track surgery” in the cardiac surgery literature in the 1990s. 1 ERAS pathways are defined by the ERAS Society as any perioperative care pathway designed to accelerate patient recovery after major surgery. 2 Elements of
Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Kurt Lehner, Mari L. Groves, Paul Sponseller, and Daniel M. Sciubba
lead to significant cost savings. Consequently, the present analysis, as a whole, suggests ERAS implementation to be a cost-effective means of safely accelerating discharge in pediatric patients undergoing surgery for scoliosis. Although increasing cost-effectiveness remains a focus across the field of spine surgery, reducing costs and improving outcomes is of particular importance in the pediatric deformity population. Surgery for pediatric deformity correction is among the most expensive pediatric procedures, with an estimated cost of up to $180,000 per patient. 2