A pre-operative gastrointestinal optimization protocol to improve outcomes after intrathecal baclofen pump surgery

Area of Science:

• Neurosurgery
• Pediatric Gastroenterology
• Healthcare Management

Background:

• Pediatric cerebral palsy patients often have medical comorbidities.
• These patients disproportionately consume hospital resources post-neurosurgery.
• Intrathecal baclofen pump surgery is common for managing spasticity in these patients.

Purpose of the Study:

• To implement and evaluate an institutional pre-operative gastrointestinal (GI) optimization protocol.
• To improve patient outcomes after neurosurgical procedures.
• To decrease hospital resource utilization in pediatric cerebral palsy patients.

Main Methods:

• A retrospective review of 323 intrathecal baclofen surgeries was conducted.
• Surgeries were categorized based on implementation of a GI optimization protocol (July 1, 2017).
• Outcomes and resource utilization were compared between pre- and post-protocol implementation groups.

Main Results:

• The GI optimization protocol significantly reduced hospital readmissions for constipation (p=0.001), eliminating GI-related emergency visits.
• A reduction of 27 hospital days for constipation-related readmissions was observed.
• No significant differences in demographics, baseline GI comorbidities, or post-operative complications (UTIs, SSIs, CSF leaks) were found between groups.

Conclusions:

• A pre-operative GI optimization protocol effectively reduces hospital readmissions and emergency department visits post-baclofen pump surgery.
• This protocol improves quality of care and lowers hospital resource utilization.
• Further research is warranted to optimize care for complex pediatric neurosurgical patients.