Abstract
Background Little evidence exists for superiority of neurosurgical outcomes from care subspecialization.
Outcomes of a single neurosurgeon after complex vascular neurosurgery in an academic
medical center were compared against those in a community hospital.
Methods In this retrospective analysis of extracranial-intracranial vascular bypass operations
performed between July 1, 2013 and February 1, 2015, cases were identified by cross-referencing
the electronic medical record with the surgeon's own records. Pre-, intra-, and postoperative
variables were abstracted from cases performed at a tertiary center and a community
hospital. Dichotomous postoperative data recorded included extubation in the operating
room (OR), readmission, and survival to discharge, and length of stay was also analyzed.
Due to small sample size and low readmission rate, Firth's penalized likelihood tests
were incorporated in the logistic regression model for parameter estimation and testing.
Results A total of 28 hemispheres in 26 patients were included: 18 hemispheres in 16 patients
at the tertiary center and 10 hemispheres in 9 patients at the community hospital.
Differences were found in operative time (tertiary mean: 7.21 + 2.5 hours, community
mean: 5.19 + 0.9 hours, p = 0.0074) and readmission to the tertiary center (p = 0.078). However, significant difference was observed only for anesthetic type (more
likely to include remifentanil and propofol at the tertiary center, p = 0.0104).
Conclusion Subspecialty care alone may be insufficient to enhance outcome after complex neurosurgical
procedures.
Keywords
moyamoya - extracranial intracranial bypass - subspecialty care - community hospital
care - neuroanesthesiology - neurosurgery
