Venous Sinus Stenting: Safety and Health Care Resource Evaluation for Optimal Recovery in an Evolving Health Care Environment

• Published in: World neurosurgery 2023-02, Vol.170, p.e236-e241
• Main Authors: Mazur-Hart, David J., Yamamoto, Erin A., Lopez Ramos, Christian G., McIntyre, Matthew K., Pang, Brandi W., Munger, Daniel N., Bagley, Jacob H., Dogan, Aclan, Bozorgchami, Hormozd, Nesbit, Gary M., Priest, Ryan A., Liu, Jesse J.
• Format: Article
• Language: English
• Subjects: Cost savings; COVID-19; Delivery of Health Care; Female; Humans; Idiopathic intracranial hypertension; Intensive Care Units; Male; Neurosurgical Procedures - adverse effects; Pseudotumor Cerebri - surgery; Recovery; Retrospective Studies; Safety; Stenosis; Stent; Venous sinus
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2022.10.115

Increasing evidence supports the effectiveness of venous sinus stenting (VSS) with favorable outcomes, safety, and expenses compared with shunting for idiopathic intracranial hypertension. Yet, no evidence is available regarding optimal postoperative recovery, which has increasing importance with the burdens on health care imposed by the coronavirus disease 2019 pandemic. We examined adverse events and costs after VSS and propose an optimal recovery pathway to maximize patient safety and reduce stress on health care resources. A retrospective review was undertaken of elective VSS operations performed from May 2008 to August 2021 at a single institution. Primary data included hospital length of stay, intensive care unit (ICU) length of stay, adverse events, need for ICU interventions, and hospital costs. Fifty-three patients (98.1% female) met the inclusion criteria. Of these patients, 51 (96.2%) were discharged on postoperative day (POD) 1 and 2 patients were discharged on POD 2. Both patients discharged on POD 2 remained because of groin hematomas from femoral artery access. There were no major complications or care that required an ICU. Eight patients (15.1%) were lateralized to other ICUs or remained in a postanesthesia care unit because the neurosciences ICU was above capacity. Total estimated cost for initial recovery day in a neurosciences ICU room was $2361 versus $882 for a neurosurgery/neurology ward room. In our cohort, ward convalescence would save an estimated $79,866 for bed placement alone and increase ICU bed availability. Our findings reaffirm the safety of VSS. These patients should recover on a neurosurgery/neurology ward, which would save health care costs and increase ICU bed availability.