Introduction:

There is limited but increasing evidence that IONM is associated with fewer neurological deficits in spinal surgery as the monitoring questionably provides sufficient warning of impending, irreversible harm but remains a contentious issue.  Furthermore, there is little evidence of whether IONM is cost saving or decreases use of hospital resources. Only statistical models exist of the cost savings made by IONM proposed ability to prevent neurological deficits. We examined the impact of cost and resource use by comparing hospital episode statistics from neurosurgical centres across the UK, which use IONM for intramedullary resections in comparison to those that do not.

Methods:

Electronic or postal questionnaires were sent to SBNS and BSCN members and affiliates. When required, these were followed with telephone consultations. This data was collated together with hospital episode statistics within the UK benchmarking database Albatross for the years from 2012 to 2015. The Albatross database was scrutinised for each trust across the UK where intramedullary spinal cord tumour resections are performed. A range of hospital episode statistics were collected for each patient including the length of stay (LOS), cost of admission, disease code, age of the patient, financial year of admission, type of admission (emergency or elective), time in theatre, critical care LOS, critical care cost, ward costs, theatre cost and the PCT they were admitted under.

Results:

Over 85% of UK neurosurgical NHS Trusts responded to our questionnaire.  63% of these Trusts contributed to hospital episode statistics albatross database. Six Trusts did not perform IONM for intramedullary spinal cord resections at the time while 15 did. Over a 3-year period 36 patients underwent intramedullary resection in centres without IONM whereas 165 did. The median difference in the length of stay was 4 days shorter for IONM and statistically significant versus a median of 11 days for centres, which did not perform IONM. Furthermore, ward costs were £662 lower in the IONM group and again of statistical significance. Although there was also a median reduction in theatre time of 46 minutes and a total admission saving of £3,700, these were not statistically significant.

Conclusion:

This multi-centre UK retrospective analysis demonstrates use of INOM reduces length of hospital stay and reduction in use of hospital resources.