On day admissions in neurosurgery: a comparative cohort study

Area of Science:

• Neurosurgery
• Health Services Research
• Health Economics

Background:

• Neurosurgical admission policies vary across UK National Health Service trusts.
• Some centers admit patients the day before surgery, while others admit on the day of surgery.
• Elective neurosurgery admission policies impact healthcare costs, complications, and length of stay.

Purpose of the Study:

• To compare surgical cancellation rates between day-of-surgery and day-before-surgery admissions for elective neurosurgery.
• To identify reasons for surgical cancellations in both admission groups.
• To evaluate the cost savings associated with a day-of-surgery admission policy.

Main Methods:

• Comparative cohort study analyzing 199 elective neurosurgery patients over 4 months.
• Patients were divided into two groups: day-of-surgery admission (87 patients) and day-before-surgery admission (112 patients).
• Surgical cancellation rates, reasons for cancellation, and cost savings were analyzed.

Main Results:

• Overall cancellation rate was 18%. Day-of-surgery admission had a 12.6% cancellation rate versus 22.3% for day-before-surgery (p=0.1).
• Day-of-surgery admission resulted in nearly £30,000 cost savings over 4 months.
• Extrapolation suggests potential annual savings of approximately £150,000.

Conclusions:

• Admitting elective neurosurgery patients on the day of surgery is a viable strategy.
• This policy does not negatively impact surgical cancellation rates.
• Day-of-surgery admission reduces unnecessary overnight hospital stays and yields substantial cost savings.