Costs and Perioperative Outcomes Associated with Open versus Endoscopic Resection of Sinonasal Malignancies with Skull Base Involvement

 

Background: Endoscopic approaches have been increasingly adopted in favor of traditional craniofacial resection in the surgical management of sinonasal malignancies. There is limited research comparing the costs, complications, and hospital length of stay (LOS) between surgical approaches, and no studies that have identified determinants of these outcomes.

Methods: We performed a retrospective review of 106 patients at a tertiary care center undergoing surgical resection of a sinonasal malignancy. Financial data were obtained from our institution’s finance department. Linear regression was used to identify factors impacting in-hospital costs, complications, and LOS.

Results: Of 106 patients, 91 received open surgery and 15 were treated with purely endoscopic approaches. There were no significant differences in cost ($19,157 versus $17,722; p = 0.69) or LOS (5.7 versus 7.4 days, p = 0.35) between the two groups. Patients in the endoscopic group had significantly higher rates of CSF leak (13% versus 1%, p < 0.01), hospital readmission (13% versus 3%, p < 0.04), and return to OR (13% versus 2%, p = 0.03). Multiple regression showed that free flap reconstruction was a significant predictor of costs, complications, and LOS (p < 0.001, p = 0.001, and p = 0.04). Perioperative complication and ICU admission were also independently predictive of costs (p < 0.001 and p < 0.001) and LOS (p < 0.001 and p = 0.01). Surgical approach (open versus endoscopic) was not a significant predictor of any financial or perioperative outcome.

Conclusion: Overall in-hospital costs are comparable between endoscopic and open approaches, and differences may be accounted for by higher rates of CSF leak in the endoscopic group. Physicians and policy makers should recognize the factors impacting financial and perioperative outcomes in the surgical management of sinonasal malignancies.