Neurology and Neurosurgery

Feb. 24, 2024

Treating complex brain tumors that need awake craniotomies is associated with significant costs. But economic evaluation by Mayo Clinic researchers has found that implementation of a dedicated awake craniotomy team is associated with cost savings and noninferior clinical outcomes.

All adult patients with single, unilateral lesions who had elective awake craniotomy at Mayo Clinic in Jacksonville, Florida, between January 2016 and December 2021, were considered for inclusion in the study. Individuals with emergent cases, preoperative opioid use, history of chronic pain or major comorbidities were excluded. A total of 164 patients were included in the study.

As described in JAMA Network Open, direct medical costs were estimated from Medicare reimbursement rates for all billed procedures.

The researchers compared costs and outcomes between two cohorts: the 56 patients who underwent awake craniotomy before standardized practices in perioperative anesthetic treatment were introduced in 2018, and the 108 patients who had awake craniotomy after that.

Key findings:

• The standardized protocol was associated with a mean savings of $7,089. It was found to be cost saving in 75.5% of all simulations in probability sensitivity analysis.
• Procedure standardization resulted in reduced length of hospital stay from a mean of 3.34 days to 2.46 days.
• Intensive care unit (ICU) stay fell from a mean of 1.32 nights to 0.99 nights.
• The 30-day readmission rate fell from 14% to 5%.
• The extent of resection and intraoperative complication rates were similar between both cohorts.

The study is the first to evaluate — in both patient outcomes and economic results — the effects of standardizing protocols and optimizing a multidisciplinary team in awake craniotomy.

"Given the demonstrable advantages to both patients and healthcare services, this study can open the discussion on implementing similar protocols in other institutions," says Alfredo Quinones-Hinojosa, M.D., chair of neurosurgery at Mayo Clinic's campus in Florida. "Our experience highlights important lessons learned from our awake craniotomy program that allowed for some patients to bypass the ICU, with same-day discharge. For appropriately selected patients, awake craniotomy has significant advantages."

For more information

Moniz-Garcia D, et al. Awake craniotomy program implementation. JAMA Network Open. 2024;7:e2352917.

Refer a patient to Mayo Clinic.