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Reducing ICU Length of Stay: The Impact of a Multidisciplinary Perioperative Pathway in Vestibular Schwannoma
Objective This study was aimed to evaluate the impact of a multidisciplinary perioperative pathway on length of stay (LOS) and postoperative outcomes after vestibular schwannoma surgery.
Setting This study was conducted in a tertiary skull base center.
Main Outcome Measures The impact of the pathway on intensive care unit (ICU) LOS was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures.
Methods Present study is a retrospective review.
Results A universally adopted perioperative pathway was developed to include standardization of preoperative education and expectations, intraoperative anesthetic delivery, postoperative nursing education, postoperative rehabilitation, and utilization of stepdown and surgical floor units after ICU stay. Outcomes were measured for 95 consecutive adult patients who underwent surgical resection for vestibular schwannoma (40 cases before implementation of the perioperative pathway and 55 cases after implementation). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group (p = 0.02). There were no significant differences in overall resource LOS postoperative complications or readmission rates between groups.
Conclusion Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU LOS in patients undergoing vestibular schwannoma surgery without compromising quality of care. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population.
Keywordsquality - vestibular schwannoma - acoustic neuroma - pathway - multidisciplinary - skull base surgery - translabyrinthine - suboccipital - retrosigmoid
Institutional Review Board Approval
Vanderbilt University Institutional Review Board approval no.: 171293.
Financial Material and Support
None to disclose.
Received: 13 May 2020
Accepted: 01 November 2020
Article published online:
04 February 2021
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- 1 National Health Expenditure Projections 2018–2027. Accessed May 8, 2019 at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf
- 2 Porter M, Teisberg E. Redefining Health Care: Creating Value-Based Competition on Results. Boston, MA: Harvard Business School Publishing; 2006
- 3 Dummit LA, Kahvecioglu D, Marrufo G. et al. Association between hospital participation in a medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA 2016; 316 (12) 1267-1278
- 4 Navathe AS, Troxel AB, Liao JM. et al. Cost of joint replacement using bundled payment models. JAMA Intern Med 2017; 177 (02) 214-222
- 5 Maddox KJ, Epstein AM. Using bundled payments to improve the patient experience. Harv Bus Rev 2018
- 6 Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer care coordination: a systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med 2017; 51 (04) 532-546
- 7 Mohr DC, Benzer JK, Vimalananda VG. et al. Organizational coordination and patient experiences of specialty care integration. J Gen Intern Med 2019; 34 (Suppl. 01) 30-36
- 8 Volpi JJ, Ridge JR, Nakum M, Rhodes JF, Søndergaard L, Kasner SE. Cost-effectiveness of percutaneous closure of a patent foramen ovale compared with medical management in patients with a cryptogenic stroke: from the US payer perspective. J Med Econ 2019; 22 (09) 883-890
- 9 Liu J, Srivastava K, Washington T. et al. Cost-effectiveness of operative versus nonoperative treatment of displaced midshaft clavicle fractures: a decision analysis. J Bone Joint Surg Am 2019; 101 (01) 35-47
- 10 Ahmed OH, Mahboubi H, Lahham S, Pham C, Djalilian HR. Trends in demographics, charges, and outcomes of patients undergoing excision of sporadic vestibular schwannoma. Otolaryngol Head Neck Surg 2014; 150 (02) 266-274
- 11 Vorasubin N, Alexander TH, Mastrodimos B, Cueva RA. Factors that affect length of hospital stay after vestibular schwannoma surgery. Otol Neurotol 2018; 39 (09) 1203-1209
- 12 Semaan MT, Wick CC, Kinder KJ, Stuyt JG, Chota RL, Megerian CA. Retrosigmoid versus translabyrinthine approach to acoustic neuroma resection: A comparative cost-effectiveness analysis. Laryngoscope 2016; 126 (Suppl. 03) S5-S12
- 13 Reardon PM, Fernando SM, Van Katwyk S. et al. Characteristics, outcomes, and cost patterns of high-cost patients in the intensive care unit. Crit Care Res Pract 2018; 2018: 5452683
- 14 Chu JK, Feroze AH, Collins K. et al. Variation in hospital charges in patients with external ventricular drains: comparison between the intensive care and surgical floor settings. J Neurosurg Pediatr 2019; 24 (01) 29-34
- 15 Stidham KR, Roberson JB. Implementation of a clinical pathway in management of the postoperative vestibular schwannoma patient. Laryngoscope 2001; 111 (11, Pt 1): 1938-1943
- 16 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147