Introduction: The literature is replete with papers reporting better outcomes in major teaching hospitals to those of smaller community hospitals. We analyzed certain metrics in all patients who underwent the Jannetta procedure, also known as microvascular decompression (MVD) from January 1, 2009 thru December 31, 2013 at Mercy Medical Center, Springfield, Massachusetts. We report on surgical time, anesthesia time, morbidity, mortality, and surgical success rates. To the best of our knowledge, this is the first report of single surgeon results from a non-academic, community hospital.
Methods: All patients who underwent the Jannetta procedure were included. Data was obtained from the anesthesia records,office and hospital charts, and phone interview.
Results: There were a total of 59 patients who each had a single Jannetta procedure during the study period. Complete anesthesia data and other data was available on 53 patients and 59 patients,respectively.Average surgical time,anesthesia time,and length of stay(LOS) were 107 minutes,171 minutes,and 2.3 days,respectively.There were no deaths,CSF rhinorrhea, wound infections,or cranial nerve deficits.77% of trigeminal neuralgia patients,92% of hemifacial spasm patients,and the one patient with glossopharyngeal neuralgia obtained complete relief of symptoms.
Conclusions: As costs of healthcare are in the spotlight nationally, additional measures that usually are not reported will likely be analyzed. These include costs associated with the hospital setting (community versus academic)and resource utilization (surgical procedure times, LOS, etc.)Longer surgical procedure times and LOS have been associated with higher complication rates. Recently,McLaughlin et al.,reported on value of care in 49 patients having MVD. Assessment of value included measures of average surgical time (230 minutes),LOS (3.27 days),complications(8 patients) , and readmissions(4 patients).To the best of our knowledge, there has not yet been a similar report of these metrics as they apply to the Jannetta procedure performed in a community hospital setting by a single surgeon. We report such a series with results favorable to those in the literature.
Patient Care: This paper will hopefully encourage others to analyze data that reflects on surgical care besides complication rates and success rates. By analyzing such data, optimal benchmarks can be established to ensure oatients are getting care of value.
Learning Objectives: By the conclusion of reviewing this paper, participants should be able to: 1)discuss future methods to determine surgical value 2)compare their own data to those presented by the authors
References: 1. Ayanian JZ, Weissman JS: Teaching hospitals and quality of care: a review of the literature. Milbank Q. 80 (3): 569-93, 2002
2. Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334: 1077–1083, 1996.
3. Burchiel KJ: A new classification for face pain. Neurosurgery 53:1164-1167, 2003
4. Jannetta PJ, McLaughlin MR, Barker FGII, Kalia KK: Microvascular decompression. The Facial Nerve. May’s Second Edition. Thieme Medical Publishers Inc. New York. 2000. pp 483-90.
5. Kalkanis SN, EsKander EN, Carter BS, Barker FGII: Microvascular decompression surgery in the United States, 1996 to 2000: mortality Rates, morbidity Rates, and the effects of hospital and surgeon volumes. Neurosurgery 52: 1251-1262, 2003
6. Lovald ST, Malkani AL, Lau E, et al. Outpatient total knee arthroplasty: A cost and outcomes analysis. Paper 411. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-10. San Francisco
7. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK: Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8, 1999
8. McLaughlin N, Buxey F, Chaw K, Martin NA: Value-based neurosurgery: the example of microvascular decompression. J Neurosurg 120: 462-472, 2014
9. Samii M, Gunther T, Iaconetta G, Muehling M, Vorkapic P, Samii A: Microvascular decompression to treat hemifacial spasm: Long-term results for a consecutive series of 143 patients. Neurosurgery 50: 712–718, 2002