A Propensity-Matched National Inpatient Sample Analysis of Laser Interstitial Thermal Therapy versus Craniotomy for Radiation Necrosis

Introduction: MRI-guided laser interstitial thermal therapy (LITT) has been shown to effectively treat radiation necrosis. While LITT provides minimally invasive advantages relative to open surgical resection, it is associated with high capital investment and disposable equipment costs. This National Inpatient Sample (NIS) analysis aimed to compare cost, morbidity, and outcomes between LITT and craniotomy for radiation necrosis and determine if they differ in cost-effectiveness.

Methods: The NIS was queried for radiation necrosis admissions treated with LITT or craniotomy from 2011-2020 using ICD-9-and-10 codes. Cost of admission was inflation adjusted to 2020. Complications included intracerebral hemorrhage, neurological deficits, infection, pulmonary embolism, and acute respiratory or renal failure. The LITT and craniotomy cohorts were propensity score-matched by age, APRDRG risk of mortality and illness severity, and admission type. Multivariable regression analysis identified independent predictors of outcomes.

Results: From 2011-2020, there were 3,144 surgically-treated cases of radiation necrosis, of which 239 (7.6%) were managed with LITT. After propensity score-matching, there were no differences in age (p=0.950), proportion of elective admissions (p=0.769), or distribution of APRDRG risk of mortality (p=0.914) and illness severity (p=0.308). LITT had shorter length of stay than craniotomy (4.9 vs. 5.1 days, p=0.001) but similar cost of admission ($40,785 vs. $32,829, p=0.164). More patients with LITT were discharged home as opposed to a skilled nursing facility or with home services than craniotomy (66.7% vs. 48.7%, p=0.028). Additionally, the LITT cohort did not have any inpatient deaths (0% vs. 0.4%, p=0.648) or complications (0% vs. 4.1%, p=0.148). On multivariable regression, LITT had greater odds of home discharge (OR=2.54, p=0.012) and lower odds of complications (OR=0.01, p< 0.001) but was not associated with admission costs (β=$9,745, p=0.068).

Conclusion : Among patients with similar presentations of radiation necrosis, LITT confers a lower risk of complications, shorter length of stay, and better discharge disposition than craniotomy without increasing admission costs.