• World Neurosurg · Oct 2024

    Cost analysis of oncological outpatient neurosurgery under general anesthesia with Hospital-at-Home based postoperative care.

    • Cristina A Peláez-Sanchez, Marcos Pajarón-Guerrero, Angelina Rodriguez-Caballero, Juan Carlos Dueñas, Ana B Piriz, Rubén Martín-Láez, Isabel Sampedro, and Carlos Velásquez.
    • Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Fundación Instituto de Investigación Marqués de Valdecilla, Cantabria, Spain.
    • World Neurosurg. 2024 Oct 29.

    ObjectiveThis study evaluates the efficiency and cost-effectiveness of an oncological outpatient neurosurgery (OON) protocol using Enhanced Recovery After Surgery (ERAS) principles in a European healthcare setting. Additionally, it assesses the impact of incorporating Hospital at Home (HaH) for perioperative follow-up on program efficiency and costs.MethodsWe analyzed a case cohort of patients who underwent OON with HaH-based postoperative follow-up for tumor removal or biopsy at a tertiary care center since 2019. A control cohort treated under standard inpatient care was also examined. Costs associated with surgery and postoperative care were meticulously calculated for both groups.ResultsThe case (n=17) and control (n=38) cohorts had comparable demographics and clinical profiles. Surgical costs, including operating room, anesthesia, and surgeon fees, were similar across groups. However, post-operative monitoring was significantly shorter for the outpatient cohort, leading to reduced observation costs (p<0.001). While the duration of follow-up care was similar, outpatient follow-up via HaH was more cost-effective, reducing overall surgery costs by approximately €2958 per patient (p<0.001) compared to inpatient care. No significant differences were observed in costs related to treatment, radiology, or lab tests between groups.ConclusionsOutpatient neurosurgery with HaH follow-up offers substantial cost savings without compromising care quality in a public health setting. Inpatient care's higher costs are largely due to bed utilization, while the integration of HaH does not add significant costs, making it a viable alternative for postoperative management.Copyright © 2024. Published by Elsevier Inc.

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