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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. OBJECTIVES: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.

journal_name

Stereotact Funct Neurosurg

journal_title

Stereotactic and functional neurosurgery

authors

Park KJ,Niranjan A,Kondziolka D,Kano H,Castillo P,Matchett JC,Flickinger JC,Lunsford LD

doi

10.1159/000332057

subject

Has Abstract

pub_date

2011-01-01 00:00:00

pages

346-56

issue

eissn

1011-6125

issn

1423-0372

pii

000332057

journal_volume

pub_type

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Combining brain diagnosis and therapy in a single strategy: the safety, reliability, and cost implications using same-day versus separate-day stereotactic procedures.