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Updated: Sep 4, 2025
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Safety and Cost Savings Associated with Reduced Inpatient Hospitalization for Microvascular Decompression
Risheng Xu1, Sumil K Nair1, Joshua Materi1
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Objectives:
Microvascular decompression (MVD) has grown as a first-line surgical intervention for severe facial pain from trigeminal neuralgia and/or hemifacial spasm. We sought to examine the safety and cost-benefits of discharging patients with MVD within 1 day of admission.
Methods:
We retrospectively reviewed patients undergoing MVD at our institution from 2008 to 2020. Patients were sorted by 1 day, 2 days, or >2 days until discharge and by year from 2008 to 2013, 2014 to 2018, or 2019 to 2020. Patient presenting characteristics, intraoperative measures, and complications were documented. Statistical differences were calculated by one-way analysis of variance and χ2 analyses.
Results:
Our cohort included 976 patients undergoing MVD, with 231 (23.6%) between 2008 and 2013, 517 (52.9%) between 2014 and 2018, and 228 (23.3%) between 2019 and 2020. Over time, postoperative admission rates to the critical care unit, total inpatient hospital admission times, and Barrow Neurological Institute scores at first follow-up decreased. Postoperative complications, including cerebrospinal fluid leak, decreased significantly. In addition, patients discharged within 1 day of admission incurred a total hospital cost of $26,689, which was $3588 lower than patients discharged within more than 1 day of admission, P < 0.0001. Discharging carefully selected patients who are appropriate for discharge within 1 day of admission could translate to a potential cost-savings of $255,346 per year in our clinical practice.
Conclusions:
In our experience, MVDs are a safe, elective intervention. Our findings suggest that postoperative day 1 discharge in patients with an uncomplicated postoperative course may be safe while improving hospital resource use.
Insights
Discharging patients within 1 day of microvascular decompression (MVD) surgery is safe and cost-effective. Early discharge for suitable patients reduces hospital costs and improves resource utilization for trigeminal neuralgia and hemifacial spasm treatments.
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Health Economics
Background:
- Microvascular decompression (MVD) is a primary surgical treatment for trigeminal neuralgia and hemifacial spasm.
- Evaluating the safety and cost-effectiveness of early hospital discharge after MVD is crucial for optimizing patient care and resource management.
Purpose of the Study:
- To assess the safety and cost-benefits of discharging patients within 1 day of undergoing microvascular decompression (MVD).
- To analyze trends in patient outcomes and hospital resource utilization over time following MVD procedures.
Main Methods:
- Retrospective review of 976 patients who underwent MVD between 2008 and 2020.
- Patients categorized by discharge time (1 day, 2 days, >2 days) and surgical year.
- Statistical analysis using ANOVA and chi-squared tests to compare patient characteristics, complications, and costs.
Main Results:
- Over time, there was a significant decrease in critical care admissions, total hospital stay, and postoperative complications like CSF leaks.
- Patients discharged within 1 day had significantly lower hospital costs ($26,689) compared to those discharged later ($30,277).
- Early discharge for selected patients could yield annual savings of over $255,000.
Conclusions:
- Microvascular decompression is a safe elective procedure.
- Postoperative day 1 discharge for uncomplicated MVD cases is safe and enhances hospital resource efficiency.
- Early discharge strategies can lead to substantial cost savings in clinical practice.
