Optimization and Economic Impact of Expedited Minimally Invasive Parafascicular Surgery (MIPS) Protocol for Spontaneous Intraparenchymal Hemorrhage.

Background Minimally invasive parafascicular surgery (MIPS) for evacuating intracerebral hemorrhage (ICH) has proven to be an effective treatment compared to medical management. At our academic center, we have adopted a strategy of early surgery (<12 hours) and aimed to assess its impact on patients undergoing MIPS from an economic standpoint. This study introduces an innovative preoperative protocol to reduce costs and improve efficiency in the healthcare setting for patients undergoing ICH evacuation. Methods A retrospective review was conducted on patients who underwent MIPS for spontaneous ICH evacuation between 2014 and 2017. The patients were stratified into two groups: expedited versus control and early versus late operation. The expedited protocol involved using either computed tomography angiography (CTA) or a stereotactic head CT for guidance during the operation.  Results Nine patients were included in the expedited protocol group, where they were taken from the emergency department (ED) for CT and CTA, followed by a surgical decision, and then directly to the operating room (OR) from the imaging center. Nine patients were included in the control group, where they were taken from the ED for CT and CTA and returned to the ED, followed by a surgical decision, then to the imaging center for a stereotactic CTH for intraoperative navigation, and then to the OR. Additionally, eleven patients were in the early operation group, and seven were in the late operation group. The mean time from ED admission to surgery was 8.2 hours for the early operation group and 62.2 hours for the late operation group (p = 0.10). The control group had 38 preoperative scans, while the expedited group had 17. The mean preoperative imaging cost decreased from $2,039 in the control to $1,003 in the expedited group (p = 0.004). Similarly, the mean preoperative imaging cost was $2,061 for the late operation group and $1,162 for the early operation group, respectively (p = 0.02). There was a 15% decrease in the postoperative hospital stay cost per patient (p > 0.05). Conclusion Patients undergoing an expedited preoperative protocol and early surgery experienced a statistically significant reduction in preoperative costs and a shorter time between ED admission and surgery. The expedited protocol may provide economic relief for patients undergoing MIPS without compromising outcomes.