Cost-effectiveness of forgoing postoperative catheter angiography after microsurgical occlusion of spinal dorsal intradural arteriovenous fistulas

Authors

Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Katherine Karahalios, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Jubran H. Jubran, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Dimitri Benner, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Kavelin Rumalla, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Ethan A. Winkler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Christopher S. Graffeo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. Electronic address: Neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

OBJECTIVE: Spinal dorsal intradural arteriovenous fistulas (DI-AVFs) represent 70% of all spinal vascular lesions. Diagnostic tools include pre- and postoperative digital subtraction angiography (DSA) and intraoperative indocyanine green videoangiography (ICG-VA). ICG-VA has a high predictive value in DI-AVF occlusion, but postoperative DSA remains a core component of postoperative protocols. The aim of this study was to evaluate the potential cost reduction of forgoing postoperative DSA after microsurgical occlusion of DI-AVFs. METHODS: Cohort-based cost effectiveness study of all DI-AVF within a prospective, single-center cerebrovascular registry from January 1, 2017, to December 31, 2021. RESULTS: Complete data including intraoperative ICG-VA and costs were available for 11 patients. Mean (SD) age was 61.5 (14.8) years. All DI-AVFs were treated with microsurgical clip ligation of the draining vein. ICG-VA showed complete obliteration in all patients. Postoperative DSA was performed for 6 patients and confirmed complete obliteration. Mean (SD) cost contributions for DSA and ICG-VA were $11,417 ($4861) and $12 ($2), respectively. Mean (SD) total costs were $63,543 ($15,742) and $53,369 ($27,609) for patients who did and did not undergo postoperative DSA, respectively. Comorbidity status was identified as the main driver of total cost (p=0.01 after adjusting for postoperative DSA status). CONCLUSIONS: ICG-VA is a powerful diagnostic tool in demonstrating microsurgical cure of DI-AVFs, with a negative predictive value of 100%. Eliminating postoperative DSA in patients with confirmed DI-AVF obliteration on ICG-VA may yield substantial cost savings, in addition to sparing patients the risk and inconvenience of a potentially unnecessary invasive procedure.

Publication Date

5-10-2023

Publication Title

World neurosurgery

E-ISSN

1878-8769

PubMed ID

37172715

Digital Object Identifier (DOI)

10.1016/j.wneu.2023.05.017

Recommended Citation

Scherschinski, Lea; Karahalios, Katherine; Srinivasan, Visish M.; Catapano, Joshua S.; Jubran, Jubran H.; Benner, Dimitri; Rumalla, Kavelin; Winkler, Ethan A.; Graffeo, Christopher S.; and Lawton, Michael T., "Cost-effectiveness of forgoing postoperative catheter angiography after microsurgical occlusion of spinal dorsal intradural arteriovenous fistulas" (2023). Neurosurgery. 1793.
https://scholar.barrowneuro.org/neurosurgery/1793