title: Combining brain diagnosis and therapy in a single strategy: the safety, reliability, and cost implications using same-day versus separate-day stereotactic procedures.
abstract: BACKGROUND
  A therapeutic radiosurgery procedure usually follows a separate diagnostic stereotactic procedure after days or weeks.
  
  
  OBJECTIVE
  To define the clinical reliability, safety, and cost implications of same-day diagnostic stereotactic biopsy and therapeutic radiosurgery.
  
  
  METHODS
  During an 8-year interval, 26 patients underwent stereotactic brain biopsy followed by immediate therapeutic stereotactic radiosurgery in a single-day combined procedure. The intraoperative diagnosis was determined using standard histopathological techniques. Diagnostic accuracy, hospital costs, and contribution margins associated with this treatment strategy were compared to those of 26 case-matched patients (controls) who underwent a stereotactic diagnostic procedure followed by a separate-day outpatient SRS procedure within 6 weeks during the same time interval.
  
  
  RESULTS
  The intraoperative diagnosis correlated with the final histopathological diagnosis in 96% of the patients. Biopsy-related morbidity did not occur in this series. The mean total costs of same-day patients was significantly lower than the costs of patients who had two-stage procedures (USD 9,077 ± 2,366 vs. 11,284 ± 3,025; p = 0.008). The net contribution to the hospital margin of USD 13,736 was not significantly different between the two management strategies.
  
  
  CONCLUSIONS
  The advantages of the same-day approach included a single stereotactic head frame application, reduced total admission time, consecutive histopathological diagnosis and therapy in a single hospital admission, and reduced total hospital costs. For patients who are highly suspected to have a brain tumor for which SRS is likely to be an effective therapeutic strategy, same-day diagnostic stereotactic biopsy followed by therapeutic SRS proved to be a safe, reliable, and cost-effective management strategy.
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Kyung-Jae
authors: KJ
authors: Park
authors: Ajay
authors: A
authors: Niranjan
authors: Douglas
authors: D
authors: Kondziolka
authors: Hideyuki
authors: H
authors: Kano
authors: Paul
authors: P
authors: Castillo
authors: Jarred C
authors: JC
authors: Matchett
authors: John C
authors: JC
authors: Flickinger
authors: L Dade
authors: LD
authors: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000191:economics / Q000379:methods*; D013238:Stereotaxic Techniques / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome