title: An economic argument in favour of endoscopic third ventriculostomy as a treatment for obstructive hydrocephalus.
abstract: This project was undertaken to examine the health resource implications of performing endoscopic third ventriculostomy as an alternative to CSF shunting in appropriate patients. We carried out a retrospective study of case records and X-rays of patients shunted de novo at the INS, Glasgow for the two year period 1990-1991. We identified all those patients who would have been suitable for endoscopic third ventriculostomy and examined the shunt complications and extra days in hospital required by these patients. A total of 150 new shunts was inserted during the two year period. Of these, 23 patients (15%)were judged suitable for endoscopic third ventriculostomy as an alternative to CSF shunting. Eight out of 23 patients required a total of 29 repeat operations and an extra 230 days in hospital due to shunt complications. Assuming an 80% success (shunt free) rate for endoscopic third ventriculostomy, we calculate that 9 operations and 74 bed days per year could be saved by using this technique. We conclude that in units undertaking a large number of CSF shunt insertions, investment in neuroendoscopic equipment, training, and expertise has the potential to release significant resources for other uses.
authors.affiliation: Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, U.K.
authors.forename: P
authors.initials: P
authors.lastname: Barlow
authors.forename: H S
authors.initials: HS
authors.lastname: Ching
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy / Q000706:statistics & numerical data; D002648:Child; D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000191:economics*; D017050:Episode of Care; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000191:economics / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D011183:Postoperative Complications / Q000191:economics; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012606:Scotland; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000191:economics*; D014696:Ventriculostomy / Q000191:economics*