Cost Savings Associated with a Nurse Driven Mobilization Protocol for Recovery after Craniotomy

Introduction: 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 subspecialties, 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 novel nurse-driven mobilization component during post-operative recovery. Here, we report 5-year outcomes of our unique institutional NERVS program.

Methods: We created a database of elective craniotomies for tumor resection from 2017-2022. 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 620 patients for analysis: 511 (82%) entered NERVS, 355 (57%) passed NERVS, 156 (25%) failed NERVS, and 109 (18%) did not enter. Among home-discharges, passed-NERVS and no-NERVS groups did not differ in age (49.8 vs 54.3 years, p=0.06), procedure duration (4.5 vs 5.0 hours, p=0.13), or pre-operative motor (9.7% vs 9.4%, p=0.82) or sensory deficit prevalence (4.0% vs 2.9%, p=0.75). Among home-discharges, hospital LOS was significantly shorter among passed-NERVS vs non-NERVS patients (3.1 vs 5.1 days, p< 0.00001); this was associated with a reduction in total hospital charges on a per-patient basis (-$57,896, p< 0.001). Pain levels, morphine equivalents, and 30-day surgical readmission rate (p=0.81) 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 craniotomy for tumor resection is associated with reduced hospitalization lengths-of-stay and total hospital charges among home-discharge patients with similar pre-operative status, without an increase surgical readmission rate. This suggests that neurosurgical patients requiring less intensive post-operative rehabilitation assessment may benefit from accelerated nurse-driven mobilization protocols.