Abstract WP287: Differences in Outcome and Cost Between Patients Admitted to Intensive Care versus the Neuroscience Unit Post Neuroendovascular Procedure

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Abstract

Rapid advancements in endovascular technologies over the past decade have increased the number of patients successfully treated with this minimally invasive technique. Consequently, utilization of hospital resources and costs has both risen. A process change at our institution allowed neuroendovascular patients hemodynamically stable and extubated to be admitted directly to the neuroscience unit (NSU) as opposed to the intensive care unit (ICU). The NSU nursing staff is specifically trained to care for neuroendovascular intervention patients and some hold advanced certification in stroke or neurosciences. This study is the first to our knowledge that compares post-operative complications and costs between groups admitted to the ICU versus the NSU after neuroendovascular treatment. Retrospective chart review of elective and emergent neuroendovascular procedures requiring inpatient admission from 01/01/2013- 06/01/2017 was conducted. Procedures included for review were carotid artery stenting, intracranial or extracranial stenting, embolization of intracranial vascular malformation, dural AV fistula, thrombectomy for stroke, or unruptured aneurysm. Patient demographics, clinical characteristics, hospitalization data and follow-up data were extracted from the electronic medical record. Procedures between 2013 and 02/28/2016 were analyzed as the pre-process change group and compared to the post-process change group after 02/28/2016. There was a transitional period of approximately 6 months in which staff was trained and patients were gradually accepted to the NSU. Of the 209 procedures reviewed, we found no significant difference in perioperative (p= 0.18) and 30 day complications (P=0.99) or in overall survival (p=0.88) between the pre (n=111) and post (n=98) process change eras. The change in admission location resulted in cost savings of approximately $670 to the institution per patient for the first day and $2466 for each additional day. These results suggest that ICU admission is not necessary for patients that are hemodynamically stable and extubated post neuroendovascular treatment. Admission to the NSU did not negatively impact patient outcomes, yet it decreased patient hospital stay costs and institutional expenses.

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