1131 Economic Analysis and Clinical Utility of Routine Versus Targeted Use of Postoperative Computed Tomography Following Intracranial Tumor Resection: ADecade-Long Multi-Surgeon Institutional Study

INTRODUCTION: The clinical use of routine CT imaging following intracranial tumor resection is a controversial topic with variable use in clinical practice, particularly regarding cranial approach, malignancy type, and patient risk factors for perioperative complications. METHODS: An institutional retrospective chart review was conducted on patients who underwent craniotomy for tumor resection from 2014-2024 performed by twelve individual surgeons. Data analyzed included incidence of obtaining postoperative CT imaging prior or in addition to MRI, indications, and resulting changes in management. A decision tree was used to model these variables with transition probabilities set at 100% and 5% for the routine and targeted imaging cohorts, respectively. A cost analysis was estimated based on compensation differentials and cost transparency datasets and adjusted for inflation to 2024 USD. Logistical regression analyses were performed to identify patient and intraoperative variables associated with clinically meaningful routine imaging. RESULTS: 1,278 patients were included. 282 (22.03%) patients obtained routine CT imaging postoperatively; only 16 scans (5.77%) effected change in management. The total expected per patient costs for each arm was $48,994 (Routine) and $48,085 (Targeted) rendering a cost savings of $909 per patient and a theoretical direct cost savings of $1,161,702 ($116,170.2/year) had a targeted approach been used across all patients in our hospital system. Only revision surgery and subtotal tumor resection neared statistical significance for clinically meaningful routine imaging. Finally, no patient experienced delayed detection of postoperative deficits without routine imaging. CONCLUSIONS: A targeted approach to postoperative CT imaging after intracranial tumor resection based on neurological exam monitoring is superior to routine imaging use in terms of cost and clinical benefit. Routine imaging may serve useful for patients undergoing revision surgery and/or subtotal resection, particularly following known intraoperative complications.