Cost savings associated with a nurse driven mobilization protocol for recovery after cranial tumor resection

Neurosurgical procedures can be associated with significant post-operative pain and diminished ability to ambulate or transfer, frequently requiring evaluation by physical / occupational therapy (PT/OT) to ensure appropriate discharge disposition. Owing to high demand for PT/OT services across surgical subspecialities, PT/OT evaluation often bottlenecks disposition. Through our established cranial Enhanced Recovery After Surgery (ERAS) pathway, Neurosurgery Enhanced Recovery Value and Safety (NERVS), our institution employs a nurse-driven mobilization component during post-operative recovery. Here, we report our eight-year experience with a unique institutional NERVS program.

This is a retrospective observational cohort study. We created a database of elective cranial tumor resections from 2017-2024. Patient demographics, hospitalization metrics, pain levels, and medications were extracted via chart review. Patients discharged home were selected for accurate comparison of outcomes. Analyses were performed in MATLAB.

We identified 1,594 elective craniotomy patients for analysis: 1,059 (66%) entered NERVS, 834 (52%) passed NERVS, 225 (14%) failed NERVS, and 535 (34%) did not enter. Among propensity-matched patients with a post-operative ICU LOS < 1 day, NERVS and no-NERVS groups did not differ in age (53.7 vs 55.1 years, p = 0.82), procedure duration (3.9 vs 3.6 h, p = 0.08), racial composition (p = 0.24-1), or tumor type (p = 0.23-0.89). Hospital LOS was significantly shorter among NERVS vs non-NERVS patients (2.9 vs 4.6 days, p < 0.001); this was associated with a reduction in total hospital charges on a per-patient basis (-$26,040, p < 0.001). Pain levels, morphine equivalents, and 30-day surgical readmission rate did not differ between home-discharge passed-NERVS and non-NERVS groups.

Our data demonstrates that nurse-driven mobilization in lieu of indiscriminate PT/OT evaluation after cranial tumor resection is associated with reduced hospitalization lengths-of-stay and total hospital charges among propensity-matched individuals, without an increase surgical readmission rate. Future mechanistic studies are necessary to determine if neurosurgical patients requiring less intensive post-operative rehabilitation assessment causally benefit from accelerated nurse-driven mobilization protocol.