P021: ANALYSIS OF HEALTH ECONOMICS AND PATIENT OUTCOMES FROM STANDARDIZED AWAKE CRANIOTOMY PRACTICES: MOVING BEYOND THE ASLEEP AWAKE ASLEEP TECHNIQUE
Han G Kim1; Elird Bojaxhi, MD2; Diogo M Garcia, MD3; David S Sabsevitz, PhD4; Lynda Christel3; Alfredo Quinones-Hinojosa, MD3; David D Freeman, MD5,6,7; 1Clinical Research Intern Scholar Program, Mayo Clinic, Jacksonville, FL; 2Department of Anesthesiology, Mayo Clinic, Jacksonville, FL; 3Department of Neurosurgery, Mayo Clinic, Jacksonville, FL; 4Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL; 5Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; 6Department of Neurology, Mayo Clinic, Jacksonville, FL; 7Department of Critical Care, Mayo Clinic, Jacksonville, FL
Introduction: Advances in neuroanesthesiology and intraoperative brain mapping strategies have allowed for awake craniotomies to continue to be a popular alternative compared to general anesthesia. In addition to improvement in post-surgical outcomes, the literature suggests that awake craniotomies may lower cost of care by reducing hospitalization course and patient enhancing recovery. With standardization of our awake craniotomy program (late 2018) we moved from the standard asleep awake asleep technique towards a regional anesthetic technique with a modified scalp block and intermittent conscious sedation. This study examines the postsurgical course and hospitalization cost due to the standardization of our practice to investigate its effects since its implemention in late 2018.
Methods: A retrospective analysis was conducted on elective pterional and frontotemporal awake craniotomies in a single institution between two time-cohorts (Pre 2016-2018 and Post 2019-2021). We excluded patients with chronic opioid use and a history of chronic pain and patients with emergent cases, preoperative opioid use, chronic pain history and major comorbidities (per ASA IV guidelines). Preoperative/Perioperative characteristics assessed included surgical diagnosis, lesion location, intraoperative complications, primary vs recurrent craniotomy, and preoperative seizures/deficits. Postoperative data collected included length of hospital stay, ICU duration in days, postoperative seizures, and readmission within 30 days. Costs were estimated from Medicare reimbursement rates for all billed procedures.
Results: A total of 164 patients met inclusion criteria: Between 2016-2018, there were 56 patients (36 male, 20 female) who had undergone awake craniotomies with a mean LOS of 3.35 days. Between 2019-present, there were 108 patients (64 male, 44 female) with a significant decrease in LOS to 2.33 days (P< 0.01).
Potentially confounding variables like age, sex, BMI, primary vs recurrent surgery, presurgical seizures, tumor type and intraoperative seizures were found to be statistically nonsignificant between the two cohorts. Furthermore, readmission within 30 days and seizures within 60 days had a nonsignificant decrease in the 2019-2021 group. An average reduction of $7,062 per patient (p<0.01) was also observed, translating into a total average savings of $762,696 in prevented costs for awake craniotomy cases occurring after implementation of the multi-disciplinary program
Conclusion: Standardization in perioperative anesthetic treatment has been linked to decreased lengths of stays and estimated costs without increased complications. The data demonstrates a statistically significant decrease in LOS over time which suggest possible improved perioperative logistical efficiency and patient selection of a dedicated ACP with potential downstream financial benefits.