• Yi Zhang, Michael Zhang, Matthew Lin, Melanie Hayden Gephart, Anand Veeravagu, John K Ratliff, and Gordon Li.
• Department of Neurosurgery, Stanford University School of Medicine, Stanford, California. Electronic address: yizhang9@stanford.edu.
• World Neurosurg. 2020 Jun 1; 138: e607-e619.

BackgroundThe operative microscope, a commonly used tool in neurosurgery, is critical in many supratentorial tumor cases. However, use of operating microscope for supratentorial tumor varies by surgeon.ObjectivesTo assess complication rates, readmissions, and costs associated with operative microscope use in supratentorial resections.MethodsA retrospective analysis was conducted using a national administrative database to identify patients with glioma or brain metastases who underwent supratentorial resection between 2007 and 2016. Univariate and multivariate analyses were used to assess 30-day complications, readmissions, and costs between patients who underwent resection with and without use of microscope.ResultsThe cohort included 12,058 glioma patients and 5433 metastasis patients. Rates of microscope use varied by state from 19.0% to 68.6%. Microscope use was associated with $5228.90 in additional costs of index hospitalization among glioma patients (P <0.001), and $2824.00 among metastasis patients (P <0.001). Rates of intraoperative cerebral edema were lower among the microscope cohort than among the nonmicroscope cohort (P <0.027). Microscope use was associated with a slight reduction in 30-day rates of neurological complications (14.7% vs. 16.7%, P = 0.048), specifically in nonspecific cerebrovascular complications. There were no differences in rates of other complications, readmissions, or 30-day postoperative costs.ConclusionsUse of operative microscope for supratentorial resections varies by state and is associated with higher cost of surgery. Microscope use may be associated with lower rates of intraoperative cerebral edema and some cerebrovascular complications, but is not associated with significant differences in other complications, readmissions, or 30-day costs.Copyright © 2020 Elsevier Inc. All rights reserved.

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