(21) Ten Year Review of Neonatal Neurosurgical Outcomes and Cost Analysis

Genesis T. Mancha, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Laura Seske, Rush University Medical Center, Department of Pediatrics, Division of Neonatology, United States; Suhagi Kadakia, Rush University Medical Center, Department of Pediatrics, Division of Neonatology, United States

Background: Neurosurgical interventions in neonates may contribute to increased Neonatal Intensive Care Unit (NICU) stay. The impact of neurosurgical interventions on length of stay (LOS) and cost is not well-documented in the literature. In addition to LOS, other factors may impact overall resource utilization. Our objective was to perform a cost analysis of neonates who underwent neurosurgical procedures.

Objectives: Our aim was to identify contributing factors in high-risk neonates who underwent neurosurgical procedures and potential sequelae to optimize NICU length of stay and decrease overall health care costs.

Design/Methods: A retrospective chart review was performed on NICU patients who underwent ventriculoperitoneal (VP) and/or subgaleal shunt placement between January 1, 2010 and April 30, 2021. Postoperative outcomes were analyzed, including LOS, revisions, infections, ED visits following discharge, and readmissions accounting for health care utilization cost.

Results: 66 neonates underwent shunt placement during our study period. 40% of infants had IVH. 81% had hydrocephalus. 11% had an identified or suspected infection within 30 days after surgery. The average LOS was 59 days versus 67 days for patients with a post-op infection. 21% visited the ED within 30 days of discharge. Of these ED visits, 57% led to readmission. Complete cost analysis was available for 35 out of 66 patients. Consistent definitions and costing methodology available since 2015 were used to complete cost analysis for 35 out of 66 patients.The average LOS was 63 days with average cost of admission of $209,703.43. Average cost for readmission was $25,757.02. Average daily cost for neurosurgical patients was $1,672.98 versus $1,298.17 for all NICU patients.

Conclusion: Neonates who underwent neurosurgical procedures had longer LOS as well as higher daily cost. LOS for infants with infections following procedures was increased by 10.6%. Further research is needed to optimize health care utilization for these high-risk neonates.