Work

Cost savings associated with a nurse driven mobilization protocol for recovery after cranial tumor resection

Year: 2025

Type: article

Abstract: BACKGROUND AND OBJECTIVES: Neurosurgical procedures can be associated with significant post-operative pain and diminished ability to ambulate or transfer, frequently requiring evaluation by physical / occupational therapy (PT/OT) to ensure appropriate discharge disposition. Owing to high demand for PT/OT services across surgical subspecialities, PT/OT evaluation often bottlenecks disposition. Through our established cranial Enhanced Recovery After Surgery (ERAS) pathway, Neurosurgery Enhanced Recovery Value and Safety (NERVS), our institution employs a nurse-driven mobilization component during post-operative recovery. Here, we report our eight-year experience with a unique institutional NERVS program. METHODS: This is a retrospective observational cohort study. We created a database of elective cranial tumor resections from 2017-2024. Patient demographics, hospitalization metrics, pain levels, and medications were extracted via chart review. Patients discharged home were selected for accurate comparison of outcomes. Analyses were performed in MATLAB. RESULTS: We identified 1,594 elective craniotomy patients for analysis: 1,059 (66%) entered NERVS, 834 (52%) passed NERVS, 225 (14%) failed NERVS, and 535 (34%) did not enter. Among propensity-matched patients with a post-operative ICU LOS < 1 day, NERVS and no-NERVS groups did not differ in age (53.7 vs 55.1 years, p = 0.82), procedure duration (3.9 vs 3.6 h, p = 0.08), racial composition (p = 0.24-1), or tumor type (p = 0.23-0.89). Hospital LOS was significantly shorter among NERVS vs non-NERVS patients (2.9 vs 4.6 days, p < 0.001); this was associated with a reduction in total hospital charges on a per-patient basis (-$26,040, p < 0.001). Pain levels, morphine equivalents, and 30-day surgical readmission rate did not differ between home-discharge passed-NERVS and non-NERVS groups. CONCLUSION: Our data demonstrates that nurse-driven mobilization in lieu of indiscriminate PT/OT evaluation after cranial tumor resection is associated with reduced hospitalization lengths-of-stay and total hospital charges among propensity-matched individuals, without an increase surgical readmission rate. Future mechanistic studies are necessary to determine if neurosurgical patients requiring less intensive post-operative rehabilitation assessment causally benefit from accelerated nurse-driven mobilization protocol.

Source: Acta Neurochirurgica

DOI: 10.1007/s00701-025-06641-1