1395. Implementation of a ProvenRecovery Program for Elective Cranial Surgery at a large integrated healthcare system: a preliminary analysis

Authors: Clemens M. Schirmer, MD, PhD, FAANS ; Michel Lacroix, MD; Stanley Pugsley, MD; Andrew Conger, MD; Raghuram Sampath, MD; Neil Martin, MD (Wilkes Barre, PA)

Introduction: ProvenRecovery after Cranial Surgery builds on principles of Enhanced Recovery After Surgery (ERAS) programs and includes multimodal, multidisciplinary perioperative care approach. It combines risk stratification and evidence-based best practices in peri- and postoperative management to accelerate the functional recovery process and improve surgical outcomes. Despite increasing evidence that supports the use of ERAS programs in gastrointestinal and pelvic surgery, to our knowledge data regarding the development of recovery programs after cranial surgery does not exist. Here we present a preliminary analysis of our implementation of the Proven Recovery Craniotomy program at multiple platforms of our large integrated health system. Methods: A multidisciplinary team approach was used to develop a ProvenRecovery program for all patients undergoing elective cranial surgery at Geisinger beginning in April 2018. Risk adjusted outcomes were prospectively tracked and independently reviewed, primary outcome measures include mortality, complications, length of stay, readmissions and cost. Measures were compared to historical comparisons cohorts and risk-adjusted peer data. Results: Through September 2018 a total of 91 care episodes were created and prospectively tracked though the global period. In 38 outcome cases with completed episode a bundle compliance of 65% was observed. In 57 episodes through September 2018 analyzed observed to expected ratios for mortality fell from 0.98 to 0, complications from 0.77 to 0.22, readmissions from 1.17 to 0.49, the average length of stay from 1.09 to 0.65 and the cost from 1.3 to 0.75. Conclusion: This preliminary analysis describes the introduction of a ProvenRecovery Program at Geisinger for elective cranial surgery. We were able to effectively implement the program across multiple platforms at a large integrated health system. Preliminary analysis demonstrates in 91 patients enrolled and 57 episodes completed significant reduction in all prospectively collected, independently validated and risk adjusted outcome measures.