ArticleNeurosurgical review2026
What preoperative testing is needed in patients undergoing treatment for unruptured intracranial aneurysms? Optimizing value-based care based on perioperative risk: a cost effectiveness analysis.
Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
objectiveElective repair of unruptured intracranial aneurysms (UIAs) has become increasingly safe, yet non-neurological complications remain a concern. Preoperative tests are frequently ordered to uncover occult comorbidities, but routine use in asymptomatic, average-risk patients often adds cost and delay without altering management. We evaluated the cost-effectiveness of common preoperative tests—electrocardiogram (ECG), coagulation and platelet-function testing (PFT), blood glucose panel (BGP), and basic metabolic panel (BMP)—stratified by perioperative risk.
methodsDecision-tree models compared performing versus omitting each test for patients undergoing elective UIA treatment. Patients were stratified as high-risk (with cardiac, renal, diabetic, or thromboembolic comorbidities) or average-risk. Lifetime costs and quality-adjusted life years (QALYs) were modeled, discounted at 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at a $100,000/QALY threshold. Sensitivity analyses tested robustness of the models.
resultsIn high-risk patients, BGP (0.83 QALYs, $2,111; NMB $39,142), ECG (0.81 QALYs, $2,600; NMB $37,844), and BMP (0.79 QALYs, $2,016; NMB $37,465) were cost-effective, each yielding higher effectiveness and lower costs compared with no testing. PFT (0.76 QALYs, $2,841; NMB $35,005) was not cost-effective. In average-risk patients, only BGP showed borderline cost-effectiveness (0.83 QALYs, $649; ICER $172,087; NMB $40,779), while ECG, BMP, and PFT added cost without benefit. Sensitivity analyses confirmed robustness, with probabilistic analysis consistently identifying BGP as the optimal test, particularly in high-risk cohorts. When all tests were modeled together, BGP provided the greatest net benefit.
conclusionsPreoperative testing in UIA patients should be selective rather than routine. Targeted testing in high-risk individuals—particularly BGP, ECG, and BMP—provides value, while blanket testing in average-risk patients adds cost and delays without benefit. Risk-based protocols may enhance value-based neurosurgical care by detecting treatable comorbidities when present while avoiding unnecessary interventions in healthy patients.
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