title: A safety, length of stay, and cost analysis of minimally invasive microsurgery for anterior circulation aneurysms.
abstract: OBJECTIVE
  The aim of our study was to evaluate minimally invasive techniques for the treatment of anterior circulation aneurysms versus standard surgery, and to calculate the impact of these techniques on health resources, length of stay, and treatment costs.
  
  
  METHODS
  A consecutive series of 24 patients with ruptured and 30 with unruptured anterior circulation aneurysms treated with minimally invasive microsurgery (MIM) by the same surgeon was compared with a matched series of standard microsurgeries (SM) conducted for 23 ruptured and 22 unruptured aneurysms. Complication rates, aneurysm obliteration, modified Rankin Scale (mRS) outcomes, length of stay, and treatment costs were assessed.
  
  
  RESULTS
  Surgical complications, aneurysm obliteration rates and mRS outcomes were comparable between MIM and SM groups in ruptured and unruptured aneurysm cohorts. MIM resulted in shorter operative times both in unruptured (102.7 ± 4.35 vs 194.7 ± 10.26 min, p < 0.0001) and ruptured aneurysms (124.3 ± 827 vs 209 ± 13.84 min, p < 0.0001). Length of stay was reduced in patients with MIM for unruptured aneurysms (1.55 ± 24 vs 4.28 ± 0.71 days, p < 0.000,1) but not in those with ruptured aneurysms. MIM reduced treatment costs of unruptured aneurysm patients, mainly through reduced utilization of inpatient resources (non-acute bed costs in CAD: 371.2 ± 80.99 vs 1440 ± 224.1, p < 0.0001), whereas costs were comparable in patients with ruptured aneurysms.
  
  
  CONCLUSIONS
  Minimally invasive surgery is a safe and effective approach for the treatment of ruptured and unruptured aneurysms of the anterior circulation. In patients with unruptured aneurysms, reduced invasiveness and shorter operative times decreased length of stay, which reflects improved patient postoperative recovery. Overall, this translated into bed resource economy and cost reduction.
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, University Health Network and University of Toronto, 399 Bathurst Street, Toronto, M5T2S8 ON, Canada.
authors.forename: Ivan
authors.initials: I
authors.lastname: Radovanovic
authors.forename: Amal
authors.initials: A
authors.lastname: Abou-Hamden
authors.forename: Susanna
authors.initials: S
authors.lastname: Bacigaluppi
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000191:economics / Q000601:surgery*; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008866:Microsurgery / Q000191:economics*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D009864:Ontario; D016896:Treatment Outcome; D055815:Young Adult