Safety and cost savings associated with reduced inpatient hospitalization for microvascular decompression. World neurosurgery Xu, R., Nair, S. K., Materi, J., Raj, D., Park, G., Medikonda, R., Alomari, S., Kim, T., Xia, Y., Huang, J., Lim, M., Bettegowda, C. 2022


Microvascular decompression (MVD) has grown as a first-line surgical intervention for severe facial pain from trigeminal neuralgia and/or hemifacial spasm. We sought to examine the safety and cost-benefits of discharging MVD patients within one day of admission.We retrospectively reviewed patients undergoing MVD at our institution from 2008-2020. Patients were sorted by 1-day, 2-day, or >2-day days until discharge and by year from 2008-2013, 2014-2018, or 2019-2020. Patient presenting characteristics, intraoperative measures, and complications were documented. Statistical differences were calculated by one-way ANOVA and Chi-squared analyses.Our cohort included 976 patients undergoing MVD with 231 (23.6%) between 2008-2013, 517 (52.9%) between 2014-2018, and 228 (23.3%) between 2019-2020. Over time, postoperative admission rates to the critical care unit, total inpatient hospital admission times, and Barrow Neurological Institute (BNI) scores at first follow-up decreased. Postoperative complications, including CSF leak, decreased significantly. Additionally, patients discharged within one day of admission incurred a total hospital cost of $26,689, which was $3,588 lower than patients discharged within more than one day of admission, p<0.0001. Discharging carefully selected patients who are appropriate for discharge within one day of admission could translate to a potential cost-savings of $255,346 per year in our clinical practice.In our experience, microvascular decompressions are a safe, elective intervention. Our findings suggest that postoperative day one discharge in patients with an uncomplicated postoperative course may be safe while improving hospital resource utilization.

View details for DOI 10.1016/j.wneu.2022.07.037

View details for PubMedID 35842175