Microsurgical vs. endoscopic excision of colloid cysts: an analysis of complications and costs Using a longitudinal administrative Database
Microsurgical vs. endoscopic excision of colloid cysts: an analysis of complications and costs Using a longitudinal administrative Database
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DOI：
10.3389/fneur.2017.00259
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发表时间：
2017-06-09
影响因子：
3.4
通讯作者：
Li, Gordon
中科院分区：
文献类型：
--
作者：
Connolly, Ian David;Johnson, Eli;Li, Gordon
目的：开放性显微手术和内窥镜手术是治疗胶样囊肿的两种主要手术方法。至于哪一个更上级，仍有争议。以前的研究包括小的队列规模。这一主题尚未调查使用国家行政索赔数据，受益于较大的patientnumber.Methods：目前的程序术语（CPT）和国际疾病分类第9版（ICD-9）的编码在住院访问被用来选择索引手术程序对应的显微手术或内窥镜切除胶样囊肿。共病，成本和并发症收集。结果：我们确定了483例患者。总的来说，240例来自显微外科队列，243例来自内窥镜队列。两组显示了相似的人口统计学和合并症概况。除癫痫发作和30天再入院外，两组之间的术后30天并发症也相似，开放手术队列中两者均较高。显微外科和内窥镜队列的癫痫发作率分别为14.7%和5.4%（p = 0.0011）。显微手术组和内镜组的30天再入院率分别为17.3%和9.6%（p = 0.0149）。指数入院费用和90天出院后支付较高的患者接受显微外科surgery execution.Conclusion：行政索赔数据分析显示，通过显微外科和内窥镜下的方法胶样囊肿切除术后的手术并发症的差异不大。在接受显微手术切除的患者中，术后癫痫发作和30天再入院的频率较高。尽管并发症情况相似，但接受显微手术切除的患者的住院费用和90天总费用较高，这表明该组的并发症可能更严重。
Objective: Open microsurgical and endoscopic approaches are the two main surgical options for excision of colloid cysts. Controversy remains as to which is superior. Previous studies consist of small cohort sizes. This topic has not been investigated using national administrative claims data which benefits from larger patient numbers.Methods: Current Procedural Terminology (CPT) and International Classification of Disease version 9 (ICD-9) coding at inpatient visit was used to select for index surgical procedures corresponding to microsurgical or endoscopic excision of colloid cysts. Comorbidities, costs, and complications were collected.Results: We identified a total of 483 patients. In all, 240 were from the microsurgical cohort and 243 were from the endoscopic cohort. The two groups displayed similar demographic and comorbidity profiles. Thirty-day post-operative complications were also similar between groups with the exception of seizures and thirty-day readmissions, both higher in the open surgical cohort. The seizure rates were 14.7 and 5.4% in the microsurgical and endoscopic cohorts, respectively (p = 0.0011). The thirty-day readmission rates were 17.3 and 9.6% in the microsurgical and endoscopic cohorts, respectively (p = 0.0149). Index admission costs and 90-day post discharge payments were higher in patients receiving microsurgical excision.Conclusion: An analysis of administrative claims data revealed few differences in surgical complications following colloid cyst excision via microsurgical and endoscopic approaches. Post-operative seizures and thirty-day readmissions were seen at higher frequency in patients who underwent microsurgical resection. Despite similar complication profiles, patients undergoing microsurgical excision experienced higher index admission costs and 90-day aggregated costs suggesting that complications may have been more severe in this group.