Cost Analysis of Complications After Craniotomy for Brain Tumor

INTRODUCTION: Postoperative complications occur in 14.3% of neurosurgical cases, with cranial cases resulting in complications three times as often as spinal operations. It is important to understand the costs posed to our health systems by common neurosurgical complications. METHODS: We employed the 2012-2018 ACS-NSQIP Participant Use File to identify adult patients undergoing elective craniotomy for brain tumor resection. Rates of major complications associated with these procedures were then generated. The costs of these complications were derived from the AHRQ statistical briefs and HAC report and extrapolated to the study population. All costs were reported in 2021 US dollars. RESULTS: 20,414 adult patients who underwent craniotomy for tumor resection were identified. 20.8% of patients sustained one or more postoperative complications. The three most frequent complications were: unplanned 30-day-readmission (9.78%), venous thromboembolism (2.99%), and surgical site infection (2.17%). Across the AHRQ data, the three most expensive complications included: surgical site infection ($28,219), myocardial infarction ($21,000), and sepsis ($18,400). No discernible trends in complication incidence were found apart from a moderate decrease in rates of unplanned readmission between 2016 and 2018. With an estimated 152,360 craniotomies for tumor resection occurring in the United States every year, the aggregate cost of patient complication after craniotomy for brain tumor approximates $55,340,017.3. CONCLUSION: Unplanned 30-day-readmission, venous thromboembolism, and surgical site infections were among the most frequent complications after craniotomy for brain tumor.