Cost savings associated with a nurse driven mobilization protocol for recovery after cranial tumor resection

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-09-02 DOI:10.1007/s00701-025-06641-1

David Zarrin, Shivani Baisiwala, Jonah Im, Keshav Goel, Myungjun Ko, Sonia Wang, Humza Zubair, Alexander Valenzuela, Tristan Bennett, Dupre Orr, Won Kim

{"title":"Cost savings associated with a nurse driven mobilization protocol for recovery after cranial tumor resection","authors":"David Zarrin, Shivani Baisiwala, Jonah Im, Keshav Goel, Myungjun Ko, Sonia Wang, Humza Zubair, Alexander Valenzuela, Tristan Bennett, Dupre Orr, Won Kim","doi":"10.1007/s00701-025-06641-1","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and objectives</h3><p>Neurosurgical procedures can be associated with significant post-operative pain and diminished ability to ambulate or transfer, frequently requiring evaluation by physical / occupational therapy (PT/OT) to ensure appropriate discharge disposition. Owing to high demand for PT/OT services across surgical subspecialities, PT/OT evaluation often bottlenecks disposition. Through our established cranial Enhanced Recovery After Surgery (ERAS) pathway, Neurosurgery Enhanced Recovery Value and Safety (NERVS), our institution employs a nurse-driven mobilization component during post-operative recovery. Here, we report our eight-year experience with a unique institutional NERVS program.</p><h3>Methods</h3><p>This is a retrospective observational cohort study. We created a database of elective cranial tumor resections from 2017–2024. Patient demographics, hospitalization metrics, pain levels, and medications were extracted via chart review. Patients discharged home were selected for accurate comparison of outcomes. Analyses were performed in MATLAB.</p><h3>Results</h3><p>We identified 1,594 elective craniotomy patients for analysis: 1,059 (66%) entered NERVS, 834 (52%) passed NERVS, 225 (14%) failed NERVS, and 535 (34%) did not enter. Among propensity-matched patients with a post-operative ICU LOS < 1 day, NERVS and no-NERVS groups did not differ in age (53.7 vs 55.1 years, <i>p</i> = 0.82), procedure duration (3.9 vs 3.6 h, <i>p</i> = 0.08), racial composition (<i>p</i> = 0.24–1), or tumor type (<i>p</i> = 0.23–0.89). Hospital LOS was significantly shorter among NERVS vs non-NERVS patients (2.9 vs 4.6 days, <i>p</i> < 0.001); this was associated with a reduction in total hospital charges on a per-patient basis (-$26,040, <i>p</i> < 0.001). Pain levels, morphine equivalents, and 30-day surgical readmission rate did not differ between home-discharge passed-NERVS and non-NERVS groups.</p><h3>Conclusion</h3><p>Our data demonstrates that nurse-driven mobilization in lieu of indiscriminate PT/OT evaluation after cranial tumor resection is associated with reduced hospitalization lengths-of-stay and total hospital charges among propensity-matched individuals, without an increase surgical readmission rate. Future mechanistic studies are necessary to determine if neurosurgical patients requiring less intensive post-operative rehabilitation assessment causally benefit from accelerated nurse-driven mobilization protocol.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06641-1.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurochirurgica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00701-025-06641-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objectives

Neurosurgical procedures can be associated with significant post-operative pain and diminished ability to ambulate or transfer, frequently requiring evaluation by physical / occupational therapy (PT/OT) to ensure appropriate discharge disposition. Owing to high demand for PT/OT services across surgical subspecialities, PT/OT evaluation often bottlenecks disposition. Through our established cranial Enhanced Recovery After Surgery (ERAS) pathway, Neurosurgery Enhanced Recovery Value and Safety (NERVS), our institution employs a nurse-driven mobilization component during post-operative recovery. Here, we report our eight-year experience with a unique institutional NERVS program.

Methods

This is a retrospective observational cohort study. We created a database of elective cranial tumor resections from 2017–2024. Patient demographics, hospitalization metrics, pain levels, and medications were extracted via chart review. Patients discharged home were selected for accurate comparison of outcomes. Analyses were performed in MATLAB.

Results

We identified 1,594 elective craniotomy patients for analysis: 1,059 (66%) entered NERVS, 834 (52%) passed NERVS, 225 (14%) failed NERVS, and 535 (34%) did not enter. Among propensity-matched patients with a post-operative ICU LOS < 1 day, NERVS and no-NERVS groups did not differ in age (53.7 vs 55.1 years, p = 0.82), procedure duration (3.9 vs 3.6 h, p = 0.08), racial composition (p = 0.24–1), or tumor type (p = 0.23–0.89). Hospital LOS was significantly shorter among NERVS vs non-NERVS patients (2.9 vs 4.6 days, p < 0.001); this was associated with a reduction in total hospital charges on a per-patient basis (-$26,040, p < 0.001). Pain levels, morphine equivalents, and 30-day surgical readmission rate did not differ between home-discharge passed-NERVS and non-NERVS groups.

Conclusion

Our data demonstrates that nurse-driven mobilization in lieu of indiscriminate PT/OT evaluation after cranial tumor resection is associated with reduced hospitalization lengths-of-stay and total hospital charges among propensity-matched individuals, without an increase surgical readmission rate. Future mechanistic studies are necessary to determine if neurosurgical patients requiring less intensive post-operative rehabilitation assessment causally benefit from accelerated nurse-driven mobilization protocol.

查看原文本刊更多论文

成本节约与护士驱动的颅内肿瘤切除术后恢复动员方案相关

背景和目的神经外科手术可伴有明显的术后疼痛和行走或转移能力下降，通常需要通过物理/职业治疗（PT/OT）进行评估，以确保适当的出院处置。由于外科专科对PT/OT服务的高需求，PT/OT评估往往成为处置的瓶颈。通过我们建立的颅脑术后增强恢复（ERAS）途径，神经外科增强恢复价值和安全性（NERVS），我们的机构在术后恢复过程中采用护士驱动的动员组件。在这里，我们报告我们在一个独特的机构神经系统系统项目中八年的经验。方法回顾性观察队列研究。我们创建了一个2017-2024年选择性颅肿瘤切除的数据库。通过图表回顾提取患者人口统计、住院指标、疼痛程度和药物。选择出院回家的患者进行准确的结果比较。在MATLAB中进行分析。结果选取1594例择期开颅手术患者进行分析：1059例（66%）进入NERVS， 834例（52%）通过，225例（14%）不通过，535例（34%）未进入。在倾向匹配的术后ICU LOS < 1天患者中，NERVS组和无NERVS组在年龄（53.7 vs 55.1岁，p = 0.82）、手术时间（3.9 vs 3.6小时，p = 0.08）、种族构成（p = 0.24-1）或肿瘤类型（p = 0.23-0.89）方面没有差异。NERVS患者与非NERVS患者相比，住院LOS显著缩短（2.9天vs 4.6天，p < 0.001）；这与每位患者住院总费用的减少有关（- 26,040美元，p < 0.001）。疼痛水平、吗啡当量和30天手术再入院率在通过神经神经系统和非神经神经系统的出院组之间没有差异。结论：我们的数据表明，在倾向匹配的个体中，在颅肿瘤切除术后，护士驱动的动员代替不加区分的PT/OT评估与住院时间和住院总费用的减少有关，而不会增加手术再入院率。未来的机制研究是必要的，以确定神经外科患者需要较少的术后康复评估是否从加速护士驱动的活动方案中获益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.