Article
Projected financial impact of chronic subdural haematoma surgical management in 2030 – Heading towards a crisis?
Voraussichtliche finanzielle Auswirkung des chirurgischen Managements chronisch Subduralhämatome in 2030: auf dem Weg in eine Krise?
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Published: | May 25, 2022 |
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Objective: Chronic subdural hematoma (cSDH) is a common disease of the elderly, increasing in incidence. Nowadays, crucial outcome-based factors as rates of recurrence requiring re-operation (RrR) and postoperative morbidity remain alarmingly high. Because of the demographic change, the financial impact of cSDH surgery on health systems could be outrageous. The aim of this study was to assess hospital charges of cSDH surgery and estimate their increase in 2030.
Methods: All patients with cSDH who were surgically treated at the authors' own institution between January 1st, 2007, and December 31st, 2017, were included. These cases were searched using the ICD-10 Code I62.02. Patient clinical complexity level (PCCL) was reported. All charges were adjusted to €2021 using inflation statistics.
Results: Altogether, 728 patients were included. RrR was observed in 18.1% (n=132), and a PCCL ≥3 in 44.5% (n=324) of the patients. Comparing the study year 2017 with 2007, there was a statistically significant increase in the incidence of surgically treated cSDH (91 vs. 34 patients/year), in patients' mean age (77.2 ± 9 years vs. 71.8 ± 11, p=0.005), in the proportion of old patients (≥65 years) (90.1% vs. 76.5%, p=0.005), in the length of stay on the intensive care unit (1.6 ± 4.5 vs. 0.5 ± 1 days, p=0.042), and in the yearly inflation-adjusted hospital charges (€844,713.04 vs. €240,929.15), especially in the cohort of old patients (p=0.025). By 2030, the mean cost per patient was estimated to reach €12,369.05 vs. €7,086.18 in 2007, i.e., €1,629,631.61/year.
Conclusion: Funding of cSDH surgical treatment must be considered an imperative challenge in the future neurosurgical practice. The lack of understanding of the disease's pathophysiology and complexity has led to a stagnation of poor outcomes of an aging population with expanding morbidity. Innovations in the medical treatment of cSDH are urgently needed to face this issue.