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  • Decreasing Length of Stay for Patients Undergoing Microvascular Decompression Does Not Affect Long Term Outcomes.

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    Henry Tait Keenan BA; Jason Liew; Dushyant Damania MBBS; Nancy T-M Kung JD; Cynthia Zink BS, PA; Babak S. Jahromi MD, PhD, FRCS(C)

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    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Current literature reports an average patient length of stay (LOS) of 2-3 days following microvascular decompression (MVD) surgery. At our institute, a new protocol was implemented to improve LOS for patients undergoing MVD. We sought to investigate any differences in outcomes and complications as a result of this protocol implementation.

    Methods: This is a single center IRB approved retrospective study. Patients undergoing MVD from 11/2008 to 03/2015 were reviewed for differences in LOS and outcome. The implemented protocol included (in all patients): (a) use of scopolamine patch to minimize postoperative nausea, (b) strict avoidance of narcotics and use of only acetaminophen or ketorolac for postoperative analgesia, (c) early removal of Foley catheter, arterial lines, and ambulation, and (d) extensive patient education regarding the procedure and postoperative expectations. No changes were made to standard operating procedures or surgical technique. Follow up results were scored as 1 (complete pain/spasm relief without medication), 2 (complete pain/spasm relief with medication), 3 (partial relief), and 4 (no relief). Patients were divided into 2 groups: “before” and “after” protocol implementation.

    Results: Of 61 patients, 31 (50.8%) patients underwent MVD after protocol implementation. There were no significant differences in age, gender, or medical comorbidities between the groups. LOS decreased significantly after protocol implementation (Before = 2 days, IQR: 2-3, versus After = 1 days IQR: 1-1). No difference was noted in outcomes among both the groups at 1, 3, and 12 months, or at last follow up. There were no differences in rates of post-procedural complications < 30-days (p=0.14) or readmission rates < 30 days (p=0.31).

    Conclusions: Implementing simple changes in perioperative care of MVD patients can half the length of stay without affecting short and long-term outcomes. These results may be readily generalizable to other centers.

    Patient Care: By shortening LOS it will decrease the total care costs for both the patient and the hospital. Furthermore, speeding up the removal of Foley catheters and arterial lines will decrease the patient’s exposure to hospital-acquired infections.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) understand that the implementation of a new MVD protocol did not affect patient outcome. 2) Describe the specific changes that were implemented. 3) Discuss in small groups the possible strengths and weaknesses of shorter LOS for both the hospital and patient.


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