Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay.

Area of Science:

• Pediatric Neurosurgery
• Healthcare Management
• Quality Improvement

Background:

• Chiari malformation is a common pediatric neurosurgical condition with variable postoperative care.
• Postoperative pain and nausea can prolong hospital stays and increase costs.
• There is a need to reduce healthcare expenditures while maintaining quality care.

Purpose of the Study:

• To evaluate the impact of a standardized postoperative care protocol on hospital length of stay (LOS) for pediatric patients with Chiari malformation.
• To assess the effect of the protocol on healthcare costs for patients and the hospital system.

Main Methods:

• Retrospective study of 132 pediatric patients undergoing Chiari decompression with expansile duraplasty.
• Analysis of pre- and post-implementation of a standardized care protocol (instituted May 2018).
• Primary outcomes included LOS and estimated financial expense; secondary outcomes included readmissions and opioid consumption.

Main Results:

• Mean LOS decreased from 55.48 hours pre-protocol to 46.39 hours post-protocol (p = 0.014).
• The proportion of patients discharged on postoperative day 1 increased from 22% to 40% (p = 0.045).
• Estimated cost savings for 100 theoretical cases were substantial, reducing costs from $927,800 to $732,900.

Conclusions:

• A standardized postoperative care protocol effectively reduced LOS for pediatric Chiari decompression surgery.
• The protocol led to significant cost reductions for the hospital system.
• Implementing standardized care can decrease healthcare costs without compromising patient care quality.