Eseonu Chikezie I, Rincon-Torroella Jordina, ReFaey Karim, Quiñones-Hinojosa Alfredo
Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland.
Neurosurgery. 2017 Aug 1;81(2):307-314. doi: 10.1093/neuros/nyx022.
Cost effectiveness has become an important factor in the health care system, requiring surgeons to improve efficacy of procedures while reducing costs. An awake craniotomy (AC) with direct cortical stimulation (DCS) presents one method to resect eloquent region tumors; however, some authors assert that this procedure is an expensive alternative to surgery under general anesthesia (GA) with neuromonitoring.
To evaluate the cost effectiveness and clinical outcomes between AC and GA patients.
Retrospective analysis of a cohort of 17 patients with perirolandic gliomas who underwent an AC with DCS were case-control matched with 23 patients with perirolandic gliomas who underwent surgery under GA with neuromonitoring (ie, motor-evoked potentials, somatosensory-evoked potentials, phase reversal). Inpatient costs, quality-adjusted life years (QALY), extent of resection, and neurological outcome were compared between the groups.
Total inpatient expense per patient was $34 804 in the AC group and $46 798 in the GA group ( P = .046). QALY score for the AC group was 0.97 and 0.47 for the GA group ( P = .041). The incremental cost per QALY for the AC group was $82 720 less than the GA group. Postoperative Karnofsky performance status was 91.8 in the AC group and 81.3 in the GA group (P = .047). Length of hospitalization was 4.12 days in the AC group and 7.61 days in the GA group ( P = .049).
The total inpatient costs for awake craniotomies were lower than surgery under GA. This study suggests better cost effectiveness and neurological outcome with awake craniotomies for perirolandic gliomas.
成本效益已成为医疗保健系统中的一个重要因素，这要求外科医生在降低成本的同时提高手术疗效。采用直接皮质刺激（DCS）的清醒开颅手术（AC）是切除明确功能区肿瘤的一种方法；然而，一些作者认为，与采用神经监测的全身麻醉（GA）下手术相比，该手术成本高昂。
评估AC与GA患者的成本效益及临床结果。
对17例接受带DCS的AC的中央沟周围胶质瘤患者进行回顾性分析，并与23例接受GA下带神经监测（即运动诱发电位、体感诱发电位、相位反转）手术的中央沟周围胶质瘤患者进行病例对照匹配。比较两组患者的住院费用、质量调整生命年（QALY）、切除范围和神经学结果。
AC组患者的住院总费用为34804美元，GA组为46798美元（P = 0.046）。AC组的QALY评分为0.97，GA组为0.47（P = 0.041）。AC组每QALY的增量成本比GA组少82720美元。AC组术后卡氏功能状态评分为91.8，GA组为81.3（P = 0.047）。AC组住院时间为4.12天，GA组为7.61天（P = 0.049）。
清醒开颅手术的住院总费用低于GA下手术。本研究表明，清醒开颅手术治疗中央沟周围胶质瘤具有更好的成本效益和神经学结果。
