Abstract
Background
Intraoperative neurophysiological monitoring (IOM) is a valuable adjunct for neurosurgical operative techniques, and has been shown to improve clinical outcomes in cranial and spinal surgery. It is not necessarily provided by NHS hospitals so may be outsourced to private companies, which are expensive and at cost to the NHS trusts. We discuss the benefits and challenges of develo** an in-house service.
Methods
We surveyed NHS neurosurgical departments across England regarding their expenditure on IOM over the period January 2018 – December 2022 on cranial neurosurgery and spinal surgery. Out of 24 units, all responded to our Freedom of Information requests and 21 provided data. The standard NHS England salary of NHS staff who would normally be involved in IOM, including physiologists and doctors, was also compiled for comparison.
Results
The total spend on outsourced IOM, across the units who responded, was over £8 million in total for the four years. The annual total increased, between 2018 and 2022, from £1.1 to £3.5 million. The highest single unit yearly spend was £568,462. This is in addition to salaries for staff in neurophysiology departments. The mean NHS salaries for staff is also presented.
Conclusion
IOM is valuable in surgical decision-making, planning, and technique, having been shown to lead to fewer patient complications and shorter length of stay. Current demand for IOM outstrips the internal NHS provision in many trusts across England, leading to outsourcing to private companies. This is at significant cost to the NHS. Although there is a learning curve, there are many benefits to in-house provision, such as stable working relationships, consistent methods, training of the future IOM workforce, and reduced long-term costs, which planned expansion of NHS services may provide.
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Acknowledgements
With thanks to Camila Garces-Bovett, Senior Information Specialist, the Royal College of Surgeons of England Library and Archives Team, for designing and running the literature searches. Thank you to all the hospitals who responded to our Freedom of Information requests.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Menaka Paranathala, Charles Fry and Stephan Jaiser. The first draft of the manuscript was written by Menaka Paranathala and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Paranathala, M.P., Jaiser, S., Hussain, M.A. et al. In-House Intraoperative Monitoring in Neurosurgery in England – Benefits and Challenges. J Med Syst 48, 24 (2024). https://doi.org/10.1007/s10916-024-02041-7
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DOI: https://doi.org/10.1007/s10916-024-02041-7