title: Value-based neurosurgery: the example of microvascular decompression surgery.
abstract: OBJECTIVE
  Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example.
  
  
  METHODS
  This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy.
  
  
  RESULTS
  Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions.
  
  
  CONCLUSIONS
  Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an "optimal episode of surgical care" in every case.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Nancy
authors.initials: N
authors.lastname: McLaughlin
authors.forename: Farzad
authors.initials: F
authors.lastname: Buxey
authors.forename: Karen
authors.initials: K
authors.lastname: Chaw
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D006304:Health Status; D019569:Hemifacial Spasm / Q000191:economics / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008297:Male; D061145:Microvascular Decompression Surgery / Q000191:economics*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000191:economics / Q000601:surgery