ABSTRACT
Introduction: Implantable telemetric intracranial pressure sensors (telesensors) enable routine, non-invasive ICP feedback which can assist with clinical decision-making and attribution of pressure-related symptoms in patients with CSF shunt systems. Here, we aim to characterise telesensor cost-effectiveness and impact on service demand. Methods: A single-centre, retrospective, cohort study and costeffectiveness analysis of 80 patients (78% Female;30% IIH, 22% Chiari malformation, 48% other) with MScio® (Christoph Miethke) telemetric ICP monitors. Service demand in the two years before and after implantation were retrieved from the centre's electronic patient record system. Intentionally, data did not overlap with the COVID-19 pandemic period. The frequencies of hydrocephalusrelated neurosurgical admissions, outpatient clinics, and scans were recorded along with A&E, neurology, and ophthalmology encounters. Tariffs were used to compare expenditure before and after implantation. Results: Significant reductions were seen in the frequencies of neurosurgical admissions (1.9/year to 0.6;p < 0.001), ICP monitoring (0.4 to 0.01;p < 0.001), and CT scans (0.5 to 0.3;p = 0.013) following implantation. There were also significant reductions in the proportion of patients requiring admissions (91% to 45%;p < 0.001) and ICP monitoring (30% to 3%;p < 0.001). There were non-significant reductions in other invasive procedures, neurology encounters, and A&E admissions. Overall, there was a £341 (SD = 1069) per patient per year saving (22% reduction in included costs). Conclusions: From an institutional perspective, the implantation of telesensors contributes to a reduction in service demand and a net financial saving. From a patient perspective, fewer appointments, invasive procedures, and radiation exposures suggest an improvement in patient experience and safety.
ABSTRACT
Introduction: Implantable telemetric intracranial pressure sensors (telesensors) enable routine, non-invasive ICP feedback which can assist with clinical decision-making and attribution of pressure-related symptoms in patients with CSF shunt systems. Here, we aim to characterise telesensor cost-effectiveness and impact on service demand. Method(s): A single-centre, retrospective, cohort study and costeffectiveness analysis of 80 patients (78% Female;30% IIH, 22% Chiari malformation, 48% other) with MScio (Christoph Miethke) telemetric ICP monitors. Service demand in the two years before and after implantation were retrieved from the centre's electronic patient record system. Intentionally, data did not overlap with the COVID-19 pandemic period. The frequencies of hydrocephalusrelated neurosurgical admissions, outpatient clinics, and scans were recorded along with A&E, neurology, and ophthalmology encounters. Tariffs were used to compare expenditure before and after implantation. Result(s): Significant reductions were seen in the frequencies of neurosurgical admissions (1.9/year to 0.6;p < 0.001), ICP monitoring (0.4 to 0.01;p < 0.001), and CT scans (0.5 to 0.3;p = 0.013) following implantation. There were also significant reductions in the proportion of patients requiring admissions (91% to 45%;p < 0.001) and ICP monitoring (30% to 3%;p < 0.001). There were non-significant reductions in other invasive procedures, neurology encounters, and A&E admissions. Overall, there was a 341 (SD = 1069) per patient per year saving (22% reduction in included costs). Conclusion(s): From an institutional perspective, the implantation of telesensors contributes to a reduction in service demand and a net financial saving. From a patient perspective, fewer appointments, invasive procedures, and radiation exposures suggest an improvement in patient experience and safety.
ABSTRACT
Objectives: The Post-operative Morbidity Survey (POMS) identifies post-operative morbidity in patients undergoing elective major surgery. The POMS was useful in various surgical fields including neurosurgery;however, a dedicated neurosurgical version of the POMS is not available. This study describes the creation, validation process, and utility of a dedicated neurosurgical POMS: the neuro-POMS. Design: Single-centre retrospective study including a consecutive series of patients undergoing major neurosurgical cranial procedures over three months (pre-COVID). Methods: Data on post-operative morbidity was collected and used to design a dedicated Neuro-POMS. The Neuro- POMS was applied to the same patient group by an independent assessor who was blinded to the initial data collection. Results of the generic POMS and neuro-POMS were compared. Results: One hundred and forty-seven patients (mean age 52, 90 females) underwent major cranial neurosurgery during the study period. The neuro-POMS assessment revealed early post-operative morbidity in 65% of the patients on a postoperative day 3 and 57% on day 8. The sensitivity of neuro- POMS was significantly higher compared to the generic version of the POMS (Fisher exact tests p < 0.001 for day 3 and p = 0.03 for day 8). Additionally, morbidity detected by the neuro-POMS allowed early prediction of the overall postoperative length of stay. Every positive item of the neuro- POMS on day 3 predicted an increase of 1.7 days in the overall length of stay (linear regression, p < 0.001, 95%CI 1.2-2.1). For day 8, the predicted increase in length of stay was 3.2 days (linear regression, p < 0.001, 95%CI 2.5-3.7). Conclusions: Neuro-POMS is a valuable tool for the early detection of post-operative morbidity after cranial neurosurgery. It is more sensitive than POMS in detecting morbidity and can predict overall hospital length of stay. Neuro-POMS could also be useful in the management of hospital beds.