gms | German Medical Science

Objective: The current study was designed to investigate the pharmaco-economic impact on in-hospital costs of postoperative CSF fistulas in patients after intracranial surgery.

Methods: 344 cases of intracranial procedures were prospectively investigated in a multicenter study. In-hospital costs for additional medical procedures to diagnose and to treat these complications were also prospectively evaluated and calculated based on the individual costs for each hospital (e.g. CMI, DRG base-rate, additional diagnostic procedures, personnel- and non personnel-costs).

Results: 22 (6.4%) of all patients developed a postoperative CSF fistula. Although outcome in general was not influenced, the presence of such fistula had some clinical impact (infections, re-operations, prolonged hospital stay). Additional costs were caused by: prolonged stay on the ICU (n=5) or the regular ward (n=8), additional operations (n=4), need for lumbar drainage (n=5), or lumbar and local punctures (n=11). Additional diagnostic procedures included 1 MRI, 12 CT-scans, and laboratory CSF analyses in 12 patients. 10 patients required prolonged antibiotic treatment.

Total costs caused by postoperative CSF fistulas were 176.221 € total (8010 € per case). Main costs were caused by a prolonged stay on the ICU (88.9% of all costs) or on the regular ward (7.6%). Additional medical interventions (re-operations, lumbar punctures etc.) were only responsible for 2.1%, additional diagnostic procedures (laboratory, CT, MRI) for only 1.4% of all costs.

Conclusions: The occurrence of a cerebrospinal fluid fistula as a complication after an intracranial procedure results in an enormous increase of in-hospital costs of 8010 €/per case which is approximately 15% of the total hospital income from all cases treated. Strategies to lower the rate of such complications are therefore urgently needed, both from a medical and from an economic point of view.