Determinants of resource utilization in the treatment of brain arteriovenous malformations

BACKGROUND AND PURPOSE: Preoperative embolization of arteriovenous malforma tions (AVMs) is thought to improve outcome following surgical resection of these lesions. The purpose of this study was to examine the cost associated with preoperative embolization and different surgical risk categories in t he surgical treatment of brain AVMs, METHODS: In a review of 126 patients treated surgically for resection of AV Ms, we noted the total days spent in the hospital and calculated the associ ated casts (from hospital and estimated professional fees). Surgical risk c ategory was determined using the Spetzler-Martin grading system. We examine d the effect of risk category, preoperative embolization, and outcome (Rank in score) on cost and inpatient days, RESULTS: Preoperative embolization and greater surgical risk were independe ntly associated with higher total costs, Average adjusted cost for emboliza tion and surgery was $78,400 +/- $4,900 versus $49,300 +/- $5,800 for surge ry alone. Patients ranged in preoperative risk category from Spetzler-Marti n grades LT through V, with an average increase of $20,100 in total cost pe r Spetzler-Martin grade (95% CI, $13,500 to $28,100), Higher surgical risk category was also associated with more days spent in hospital, with an aver age increase of 6 days per increment in Spetzler-Martin grade (95% CI, 4 to 8, After surgical resection of an AVM, new neurologic deficits were associ ated with large differences in cost: $68,500 +/- $6,100 and 15 +/- 2 days i n hospital for patients who were neurologically worse after surgery, versus $44,700 +/- $3,900 and 10 +/- 1 days for patients who were unchanged. CONCLUSION: Preoperative embolization in the treatment of AVMs is associate d with higher cost but not more days in the hospital, Patients with higher Spetzler-Martin grade AVMs utilize more hospital resources, in part because they have poorer neurologic outcome, and postoperative deficits are associ ated with higher costs and more days in the hospital.