title: Assessing the cost of contemporary pituitary care.
abstract: OBJECTIVE
  Knowledge of the costs incurred through the delivery of neurosurgical care has been lagging, making it challenging to design impactful cost-containment initiatives. In this report, the authors describe a detailed cost analysis for pituitary surgery episodes of care and demonstrate the importance of such analyses in helping to identify high-impact cost activities and drive value-based care.
  
  
  METHODS
  This was a retrospective study of consecutively treated patients undergoing an endoscopic endonasal procedure for the resection of a pituitary adenoma after implementation and maturation of quality-improvement initiatives and the implementation of cost-containment initiatives.
  
  
  RESULTS
  The cost data pertaining to 27 patients were reviewed. The 2 most expensive cost activities during the index hospitalization were the total operating room (OR) and total bed-assignment costs. Together, these activities represented more than 60% of the cost of hospitalization. Although value-improvement initiatives contributed to the reduction of variation in the total cost of hospitalization, specific cost activities remained relatively variable, namely the following: 1) OR charged supplies, 2) postoperative imaging, and 3) use of intraoperative neuromonitoring. These activities, however, each contributed to less than 10% of the cost of hospitalization. Bed assignment was the fourth most variable cost activity. Cost related to readmission/reoperation represented less than 5% of the total cost of the surgical episode of care.
  
  
  CONCLUSIONS
  After completing a detailed assessment of costs incurred throughout the management of patients undergoing pituitary surgery, high-yield opportunities for cost containment should be identified among the most expensive activities and/or those with the highest variation. Strategies for safely reducing the use of the targeted resources, and related costs incurred, should be developed by the multidisciplinary team providing care for this patient population.
authors.affiliation: Departments of Neurosurgery.
authors.forename: Nancy
authors.initials: N
authors.lastname: McLaughlin
authors.affiliation: Departments of Neurosurgery.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martin
authors.affiliation: Departments of Neurosurgery.
authors.forename: Pooja
authors.initials: P
authors.lastname: Upadhyaya
authors.affiliation: Departments of Neurosurgery.
authors.forename: Ausaf A
authors.initials: AA
authors.lastname: Bari
authors.affiliation: Departments of Neurosurgery.
authors.forename: Farzad
authors.initials: F
authors.lastname: Buxey
authors.affiliation: Head and Neck Surgery, and.
authors.forename: Marilene B
authors.initials: MB
authors.lastname: Wang
authors.affiliation: Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Heaney
authors.affiliation: Departments of Neurosurgery.
authors.forename: Marvin
authors.initials: M
authors.lastname: Bergsneider
mesh_terms: D000236:Adenoma / Q000191:economics* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D003363:Cost Control / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000191:economics*; D009873:Operating Rooms / Q000191:economics; D010819:Physician's Role; D010911:Pituitary Neoplasms / Q000191:economics* / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: ACA = Affordable Care Act; ICU = intensive care unit; IOM = intraoperative monitoring; LOS = length of stay; OR = operating room; POD = postoperative day; cost; intraoperative monitoring; pituitary adenoma; quality; resources; value