title: Pharmacoeconomical consequences of postoperative CSF leaks after intracranial surgery--a prospective analysis.
abstract: Cerebrospinal fluid (CSF) leaks are well-known and frequent complications of intracranial procedures with their clinical aspects covered by numerous studies. Little, however, is known about the pharmacoeconomical aspects of this specific complication. 545 patients with a variety of intracranial procedures (elective and trauma) were recruited for a multicenter, prospective, observational study over a 13-month period. A specific pharmacoeconomic analysis was performed in 168 of these patients from the institution of the first author covering all clinical and pharmaco-economical aspects of this specific complication. Of all patients, 5.36% developed a postoperative CSF leak. Treatment of the leak required numerous diagnostic and therapeutic procedures such as reoperations (n = 6), lumbar punctures (n = 11) or lumbar drainages (n = 4). Costs for these procedures and prolonged hospital stays nearly doubled the costs per case (€14079/case without a fistula vs. €25499/case with a fistula). Reimbursement for the hospital covered these extra costs, but net earnings per case were diminished by €565 in cases with a CSF leak. The authors conclude that the presence of a CSF leak after an intracranial operation - although not influencing outcome in general - results in additional diagnostic and therapeutic procedures for the patient, an enormous increase in costs for the community, and a financial loss for the hospital. Strategies to lower this complication rate should therefore urgently be developed both from a clinical and a pharmacoeconomical point of view.
authors.affiliation: University of Rostock, Department of Neurosurgery, Rostock, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Piek
authors.affiliation: University of Rostock, Department of Neurosurgery, Rostock, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Weber
authors.affiliation: University of Rostock, Institut für Biostatistik und Informatik in Medizin und Alternsforschung, Rostock, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kundt
authors.affiliation: Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Department of Neurosurgery, Lübeck, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Tronnier
authors.affiliation: Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Department of Neurosurgery, Lübeck, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Spuck
authors.affiliation: Asklepios Klinik Hamburg-Altona, Abteilung für Neurochirurgie, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hirdes
authors.affiliation: Asklepios Klinik Hamburg-Altona, Abteilung für Neurochirurgie, Hamburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kehler
authors.affiliation: University of Rostock, Department of Neurosurgery, Rostock, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ditges
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000191:economics* / Q000209:etiology; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000191:economics*; D011446:Prospective Studies; D012086:Reoperation / Q000191:economics; D013129:Spinal Puncture / Q000191:economics*