|Journal||The Canadian Journal of Neurological Sciences|
|Publisher||Canadian Journal of Neurological Sciences|
|Issue||Volume 37, Number 5 / September 2010|
|Online Date||Thursday, August 19, 2010|
1School of Medicine, Queen's University, Kingston
2Department of Otolaryngology - Head & Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
3Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
Background: Post-operative cerebrospinal fluid (CSF) leaks are a common complication of endoscopic pituitary surgery and account for a significant proportion of hospital costs associated with this procedure. Tisseel® is a tissue glue commonly used as an adjunct in dural repair but is not optimal for this purpose. DuraSeal® has several properties advantageous for dural repair but is not widely accepted in Canada partly due to its increased cost.
Objective: A cost analysis of DuraSeal® versus Tisseel® in endoscopic pituitary surgery.
Methods: A cost analysis was performed based on typical endoscopic pituitary surgery cases performed at our tertiary care institution. Operating room, hospital admission, and surgical sealant costs were obtained directly while estimates of patient recovery time and post-operative CSF leak rates were based on consensus values reported in the literature. Outcomes were reported for various possible clinical scenarios of sealant use.
Results: In a model where surgical sealant is employed only in high-risk cases, use of DuraSeal® allows for a yearly cost savings of at least 4486.72. If surgical sealant is used in all cases, regular use of DuraSeal® versus Tisseel® either marginally reduces yearly costs or increases them by a maximum of7619.25, depending on the case volume and estimated post-operative CSF leak rate.
Conclusion: In most clinical scenarios, use of DuraSeal® in endoscopic pituitary surgery may reduce overall yearly hospital costs compared to Tisseel®.