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J Neurol Surg B Skull Base 2022; 83(05): 515-525
DOI: 10.1055/s-0041-1740395
Original Article

90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients

Nicholas Dietz   *
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Mayur Sharma    *
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Kevin John
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Dengzhi Wang
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Beatrice Ugiliweneza
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Sriprakash Mokshagundam
2   Department of Endocrinology, University of Louisville, Louisville, Kentucky, United States
,
Martin F. Bjurström
3   Department of Anesthesiology and Intensive Care, Skane University Hospital, Lund Sweden
,
Maxwell Boakye
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Brian J. Williams
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
,
Norberto Andaluz
1   Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Abstract

Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown.

Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection.

Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up.

Setting The study included national inpatient hospitalization and outpatient visits.

Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC).

Interventions This study investigated transphenoidal or subfrontal approach for tumor resection.

Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study.

Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001).

Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.

Keywords

craniopharyngioma - bundle payments - complications - economics

* Authors share first authorship.


Supplementary Material



Publication History

Received: 12 September 2020

Accepted: 05 November 2021

Article published online:
16 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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