Roth Steven G, Ahn Seoiyoung, Liles Campbell, Velagapudi Lohit, Mummareddy Nishit, Ko Yeji, Hilvert Austin M, Froehler Michael T, Fusco Matthew R, Chitale Rohan V
Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Interv Neuroradiol. 2024 Oct 10:15910199241288880. doi: 10.1177/15910199241288880.
No consensus exists on the necessity of neurocritical care unit (NCU)-level care following unruptured intracranial aneurysm (UIA) treatment. We aim to identify patients requiring NCU-level care post-treatment and determine potential cost savings utilizing a selective NCU admission protocol.
A retrospective analysis of all UIA patients who underwent endovascular treatment at a single center from 2017-2022 was conducted. Data on demographics, preprocedural variables, radiographic features, procedural techniques, intra/postoperative events, and length of stay (LOS) were collected. Multivariable analysis was performed to identify patients requiring NCU-level care post-treatment. Cost analysis using hospital cost data (not charges/reimbursement) was performed using simulated step-down and floor protocols for patients without NCU indications following a hypothetical six-hour post-anesthesia care unit observation period.
Of 209 patients, 179 were discharged within 24 h and 30 had prolonged LOS. In our analysis, intra- and postoperative events independently predicted prolonged LOS. In our subanalysis, 47 patients demonstrated NCU needs: 24 with intraoperative indications, 18 with postoperative indications, and five with both. Of the 23 with postoperative indications, 20 were identified within six hours, while three were identified within six to 24 h. The median variable cost per patient for the current NCU protocol was $31,505 (IQR, $26,331-$37,053) vs. stepdown protocol $29,514 (IQR, $24,746-$35,011;p = 0.061) vs. floor protocol $26,768 (IQR, $22,214-$34,107;p < 0.001). Total variable costs were $6,211,497 for the current NCU protocol vs. $5,921,912 for the step-down protocol (4.89% savings) and $5,509,052 for the floor protocol (12.75% savings).
Most patients requiring NCU-level care following UIA treatment were identified within a six-hour postoperative window. Thus, selective NCU admission for this cohort following a six-hour observation period may be a logical avenue for cost reduction. Our analysis demonstrated 5% and 13% savings for uncomplicated patients using step-down and floor admission protocols, respectively.
对于未破裂颅内动脉瘤（UIA）治疗后是否需要神经重症监护病房（NCU）级别的护理，目前尚无共识。我们旨在确定治疗后需要NCU级护理的患者，并通过选择性NCU入院方案确定潜在的成本节约。
对2017年至2022年在单一中心接受血管内治疗的所有UIA患者进行回顾性分析。收集了人口统计学、术前变量、影像学特征、手术技术、术中/术后事件以及住院时间（LOS）的数据。进行多变量分析以确定治疗后需要NCU级护理的患者。在假设的术后六小时麻醉后护理单元观察期后，使用模拟的逐步降级和最低护理方案，利用医院成本数据（而非收费/报销）进行成本分析，针对无NCU指征的患者。
209例患者中，179例在24小时内出院，30例住院时间延长。在我们的分析中，术中和术后事件独立预测住院时间延长。在我们的亚分析中，47例患者显示需要NCU护理：24例有术中指征，18例有术后指征，5例两者都有。在有术后指征的23例患者中，20例在六小时内被识别，3例在六至24小时内被识别。当前NCU方案每位患者的可变成本中位数为31,505美元（四分位间距，26,331美元至37,053美元），逐步降级方案为29,514美元（四分位间距，24,746美元至35,011美元；p = 0.061），最低护理方案为26,768美元（四分位间距，22,214美元至34,107美元；p < 0.001）。当前NCU方案的总可变成本为6,211,497美元，逐步降级方案为5,921,912美元（节省4.89%），最低护理方案为5,509,052美元（节省12.75%）。
大多数UIA治疗后需要NCU级护理的患者在术后六小时内被识别。因此，对于该队列在六小时观察期后进行选择性NCU入院可能是降低成本的合理途径。我们的分析表明，使用逐步降级和最低护理入院方案，无并发症患者分别节省5%和13%。
