title: Unmet need for specialised rehabilitation following neurosurgery: can we maximise the potential cost-benefits?
abstract: OBJECTIVE
  To identify the needs for specialised rehabilitation provision in a cohort of neurosurgical patients; to determine if these were met, and to estimate the potential cost implications and cost-benefits of meeting any unmet rehabilitation needs.
  
  
  METHODS
  A prospective study of in-patient admissions to a regional neurosurgical ward. Assessment of needs for specialised rehabilitation (Category A or B needs) was made with the Patient Categorisation Tool. The number of patients who were referred and admitted for specialised rehabilitation was calculated. Data from the unit's submission to the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database 2012-2015 were used to estimate the potential mean lifetime savings generated through reduction in the costs of on-going care in the community.
  
  
  RESULTS
  Of 223 neurosurgical in-patients over 3 months, 156 (70%) had Category A or B needs. Out of the 105 patients who were eligible for admission to the local specialised rehabilitation service, only 20 (19%) were referred and just 11 (10%) were actually admitted. The mean transfer time was 70.2 (range 28-127) days, compared with the national standard of 42 days. In the 3-year sample, mean savings in the cost of on-going care were £568 per week. Assuming a 10-year reduction in life expectancy, the approximate net lifetime saving for post-neurosurgical patients was estimated as at least £600K per patient. We calculated that provision of additional bed capacity in the specialist rehabilitation unit could generate net savings of £3.6M/bed-year.
  
  
  CONCLUSIONS
  This preliminary single-centre study identified a considerable gap in provision of specialised rehabilitation for neurosurgical patients, which must be addressed if patients are to fulfil their potential for recovery. A 5-fold increase in bed capacity would cost £9.3m/year, but could lead to potential net savings of £24m/year. Our findings now require confirmation on a wider scale through prospective multi-centre studies.
authors.affiliation: a Department of Rehabilitation Medicine, Osborn Neurorehabilitation Unit , Sheffield Teaching Hospitals , Sheffield , UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Singh
authors.affiliation: b Department of Neurosurgery , Sheffield Teaching Hospitals , Sheffield , UK.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sinha
authors.affiliation: c UK Rehabilitation Outcomes Collaborative (UKROC) , London , UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Bill
authors.affiliation: c UK Rehabilitation Outcomes Collaborative (UKROC) , London , UK.|d Department of Palliative Care, Policy and Rehabilitation, Faculty of Life Sciences and Medicine , King's College London , London , UK.
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006742:Hospital Bed Capacity / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics* / Q000534:rehabilitation*; D011182:Postoperative Care / Q000191:economics* / Q000379:methods*; D011446:Prospective Studies; D012017:Referral and Consultation; D012046:Rehabilitation / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
keywords: Rehabilitation; cost-efficiency; dependency; neurological conditions; outcome measurement