Mohammed Patel
Introduction
Vagal nerve stimulators (VNS) help seizure control in patients with intractable epilepsy. They require a battery or implanted pulse generator (IPG) to function, and surgical exchange once the battery has degraded. Whilst most centres use an inpatient facility, we have moved these cases to a dedicated day-case surgery centre (DSC). Our study assesses the feasibility of this move, and the impact it has had on patients and productivity.
Methods
We collected data on all inpatient and day case IPG changes over three years, all performed by the same surgeon. Data included demographics, epilepsy syndrome, IPG model, length of surgery, time to discharge, and complications. Economic analysis was done separately.
Results
29 patients underwent inpatient IPG changes, with 56 in DSC. Mean age was 40 and 44 respectively, with 38% of inpatients and 59% at DSC female. 17% in the inpatient cohort had intellectual disability, whilst this was 42% in the DSC cohort. Mean cases performed on inpatient lists were 3, and this was 7 at DSC. Length of surgery was comparable at 23 and 20 minutes. Average time to discharge was 12 hours for inpatients, but 2.3 hours for DSC patients. There were no on-the-day complications or conversion to inpatient care for DSC patients.
Conclusion
Not only is IPG change feasible in a standalone DSC unit, it has improved our productivity and time to discharge significantly even across a more challenging cohort of patients. Our practice reflects this now to IPG changes only being performed at a standalone DSC.
Authors
Mohammed Ashraf Patel, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
Julieta O'Flaherty, Livanova, York, United Kingdom & University of York, York, United Kingdom
Lorraine Laws, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
Mohsin Iqbal, Livanova, Manchester, United Kingdom
Adam Razak, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom