微血管减压术(MVD)已发展成为三叉神经痛和/或面肌痉挛引起的严重面部疼痛的一线手术干预措施。我们试图检查入院后1天内MVD患者出院的安全性和成本效益。
我们回顾性分析了2008年至2020年在我们机构接受MVD的患者。患者按1天排序,2天,或>2天直至出院,按2008年至2013年、2014年至2018年或2019年至2020年划分。患者呈现特征,术中措施,并记录了并发症。通过单因素方差分析和χ2分析计算统计学差异。
我们的队列包括976例MVD患者,2008年至2013年为231人(23.6%),2014年至2018年为517人(52.9%),2019年至2020年为228人(23.3%)。随着时间的推移,重症监护病房的术后入院率,住院总住院时间,巴罗神经研究所在第一次随访时得分下降。术后并发症,包括脑脊液漏,显著下降。此外,入院后1天内出院的患者总住院费用为$26689,比入院后1天内出院的患者低$3588,P<0.0001。在我们的临床实践中,将精心挑选的适合在入院后1天内出院的患者出院,可能会节省每年255,346美元的潜在成本。
根据我们的经验,MVD是个保险箱,选择性干预。我们的发现表明,术后第1天出院的患者没有复杂的术后过程可能是安全的,同时改善医院资源的使用。
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 patients with MVD within 1 day of admission.
We retrospectively reviewed patients undergoing MVD at our institution from 2008 to 2020. Patients were sorted by 1 day, 2 days, or >2 days until discharge and by year from 2008 to 2013, 2014 to 2018, or 2019 to 2020. Patient presenting characteristics, intraoperative measures, and complications were documented. Statistical differences were calculated by one-way analysis of variance and χ2 analyses.
Our cohort included 976 patients undergoing MVD, with 231 (23.6%) between 2008 and 2013, 517 (52.9%) between 2014 and 2018, and 228 (23.3%) between 2019 and 2020. Over time, postoperative admission rates to the critical care unit, total inpatient hospital admission times, and Barrow Neurological Institute scores at first follow-up decreased. Postoperative complications, including cerebrospinal fluid leak, decreased significantly. In addition, patients discharged within 1 day of admission incurred a total hospital cost of $26,689, which was $3588 lower than patients discharged within more than 1 day of admission, P < 0.0001. Discharging carefully selected patients who are appropriate for discharge within 1 day of admission could translate to a potential cost-savings of $255,346 per year in our clinical practice.
In our experience, MVDs are a safe, elective intervention. Our findings suggest that postoperative day 1 discharge in patients with an uncomplicated postoperative course may be safe while improving hospital resource use.