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Benefit of neurophysiologic monitoring for pediatric cardiac surgery
E H Austin1, H L Edmonds, S M Auden
1Department of Surgery, University of Louisville School of Medicine, Ky., USA.
Insights
Intraoperative neurophysiologic monitoring in pediatric cardiac surgery can reduce adverse neurologic events and shorten hospital stays. This approach offers significant cost savings for both patients and hospitals.
Area of Science:
- Pediatric Cardiac Surgery
- Neurocritical Care
- Medical Monitoring
Background:
- Pediatric patients undergoing congenital cardiac repair face high risks of neurologic complications.
- This study investigates the efficacy of intraoperative neurophysiologic monitoring in mitigating these risks.
Purpose of the Study:
- To evaluate the impact of interventions guided by neurophysiologic monitoring on postoperative neurologic sequelae.
- To assess the effect of such monitoring on hospital length of stay as a cost-efficiency measure.
Main Methods:
- A retrospective cohort study monitored 250 pediatric patients using electroencephalography, transcranial Doppler, and cerebral oximetry.
- An interventional algorithm was employed to address detected cerebral perfusion or oxygenation deficits.
Main Results:
- 70% of patients exhibited noteworthy changes in brain perfusion or metabolism.
- Interventions were appropriate in 74% of these cases.
- Neurologic sequelae were significantly lower in the intervention group (6%) compared to no-intervention (26%).
- Hospital length of stay was reduced, with 51% of the intervention group discharged within a week versus 32% in the no-intervention group.
Conclusions:
- Interventions based on neurophysiologic monitoring appear effective in reducing postoperative neurologic issues and hospital stay duration.
- The cost-effectiveness analysis indicates that neurophysiologic monitoring is a profitable service for both patients and hospitals.
- Caution is advised due to the non-randomized nature of the study.
Background:
Pediatric patients undergoing repair of congenital cardiac abnormalities have a significant risk of an adverse neurologic event. Therefore this retrospective cohort study examined the potential benefit of interventions based on intraoperative neurophysiologic monitoring in decreasing both postoperative neurologic sequelae and length of hospital stay as a cost proxy.
Methods:
With informed parental consent approved by the institutional review board, electroencephalography, transcranial Doppler ultrasonic measurement of middle cerebral artery blood flow velocity, and transcranial near-infrared cerebral oximetry were monitored in 250 patients. An interventional algorithm was used to detect and correct specific deficiencies in cerebral perfusion or oxygenation or to increase cerebral tolerance to ischemia or hypoxia.
Results:
Noteworthy changes in brain perfusion or metabolism were observed in 176 of 250 (70%) patients. Intervention that altered patient management was initially deemed appropriate in 130 of 176 (74%) patients with neurophysiologic changes. Obvious neurologic sequelae (i.e., seizure, movement, vision or speech disorder) occurred in five of 74 (7%) patients without noteworthy change, seven of 130 (6%) patients with intervention, and 12 of 46 (26%) patients without intervention (p = 0.001). Survivors' median length of stay was 6 days in the no-change and intervention groups but 9 days in the no-intervention group. In addition, the percentage of patients in the no-intervention group discharged from the hospital within 1 week (32%) was significantly less than that in either the intervention (51%, p = 0.05) or no-change (58%, p = 0.01) groups. On the basis of an estimated hospital neurologic complication cost of $1500 per day, break-even analysis justified a hospital expenditure for neurophysiologic monitoring of $2142 per case.
Conclusions:
Interventions based on neurophysiologic monitoring appear to decrease the incidence of postoperative neurologic sequelae and reduce the length of stay. Inasmuch as the break-even cost for neurophysiologic monitoring is more than four times the actual average charge, both patients and hospital may profit from this service. Because this study was not a truly randomized clinical trial, unintentional statistical bias may have occurred and caution is urged in interpreting the magnitude of apparent intergroup outcome differences.