Moving Lumbar Drain Placement to IR From the Operating Room Creates Time and Cost Savings.

Abstract

Surgeons often place lumbar drains (LD) perioperatively in patients undergoing repair for spontaneous cerebrospinal fluid (CSF) rhinorrhea. We analyzed the cost implications of a transition from operating room (OR) LD placement to a separate Interventional Radiology suite (IR) on the morning of surgery. Retrospective cohort study. Tertiary care center. We analyzed patients undergoing endoscopic repair of spontaneous CSF rhinorrhea with LD placement from August 2015 to June 2023. Patient factors and inflation-adjusted perioperative costs were compared between groups. Eighty patients were identified, including 42 patients with OR LD placement and 38 patients in IR. All LDs placed prior to August 2019 were performed in the OR, and all after in IR. Most patients were female (86.3%) with average patient age and BMI of 52.8 years and 37.8 kg/m², respectively. Both direct labor costs and operating room time direct costs were significantly higher among the OR group ($7647.37 vs $6169.66, P = .020; $5150.96 vs $4472.51, P = .012). Accordingly, non-surgical OR time was significantly shorter among patients with LD placement by IR (80.7 vs 97.6 minutes, P = .014). Transition from routine OR LD placement to a separate IR suite was associated with savings of about $1500 in direct labor costs per procedure for the hospital, reflecting the reduction in operating room time and associated personnel costs. Importantly, placement of LD in a separate suite allows for increased OR efficiency and productivity by the Otolaryngology team, which may perform an additional procedure prior to the CSF leak repair case.