146 Routine Outpatient Imaging Follow-up for Subdural Hematomas Provides Limited Clinical Benefit

Thomas Gianaris, Shaheryar Ansari, Richard Rodgers

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Mounting health care costs and pressure from insurance companies and the federal government have led to a growing need to reduce excess medical expenditures. Subdural hematomas are an increasingly large proportion of neurosurgical consults, with an associated high rate of imaging and clinic visits. Efforts to reduce these clinic visits may help to slow rising health care costs and decrease redundant follow-ups.

METHODS: From February 2007 to May 2012, 341 follow-up clinic visits for patients with traumatic subdural hematomas presenting to Indiana University Health Methodist Hospital in Indianapolis were retrospectively reviewed for imaging use, return to clinic visits, and costs.

RESULTS: At the initial follow-up visit, 312 patients had resolved, improved, or stable head CT scans and 27 had worsened or evolving hematomas. Patients were discharged without further follow-up in 268 cases, ordered to return to clinic with a new head CT in 68 cases, and underwent a revision surgery in 1 case, an asymptomatic patient with increasing hematoma. Of those 68 ordered to return to clinic, 38 patients had 1 additional follow-up visit before discharge, 7 patients had 2 more visits, and 2 patients had 3 visits after the initial follow-up, with the remainder not returning. Only one of these required a surgery, at the time of his first return to clinic. Each nurse practitioner clinic visit had an average billing of $105 USD and a national average billing of $370 to $1200 USD for each head CT.

CONCLUSION: In the overwhelming majority of cases, follow-up clinic visits and imaging studies performed routinely in an outpatient setting for traumatic subdural hematoma have significant health care costs and do not directly influence further surgical or medical management.

Original languageEnglish (US)
Number of pages1
JournalNeurosurgery
Volume63
DOIs
StatePublished - Aug 1 2016

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Subdural Hematoma
Ambulatory Care
Outpatients
Health Care Costs
Head
Hematoma
Federal Government
Nurse Practitioners
Patient Discharge
Health Expenditures
Insurance
Reoperation
Pressure
Costs and Cost Analysis
Health

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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146 Routine Outpatient Imaging Follow-up for Subdural Hematomas Provides Limited Clinical Benefit. / Gianaris, Thomas; Ansari, Shaheryar; Rodgers, Richard.

In: Neurosurgery, Vol. 63, 01.08.2016.

Research output: Contribution to journalArticle

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