Search

• Single-surgeon policy improves MVD for TN outcomes in LMICs. • Referral rate increases, surgery waiting time decreases with single-surgeon policy. • Superior pain control, fewer surgeries in single-surgeon MVD. • Residents participate after single-surgeon policy. Microvascular decompression (MVD) is effective for refractory trigeminal neuralgia (TN), but its accessibility is often limited in lower-to-middle-income countries (LMICs). This study aims to assess the impact of implementing a single-surgeon policy on MVD for TN in LMICs. A prospective cohort study was conducted from 2014 to 2020, comparing outcomes between multi-surgeon and single-surgeon policies. Residents were included in MVD procedures starting in 2019. The Barrow Neurological Institute (BNI) pain scale (P), numbness scale (N), and result conclusion scale (P + N) were used to evaluate outcomes (1 week, 1 month, 1 year, and yearly thereafter). Propensity score matching was performed before comparing the groups. Pain-free survival was assessed using Kaplan-Meier and Cox-regression analysis. We comprehensively analyzed data from 72 patients with a minimum one-year follow-up. The implementation of the single-surgeon policy had several notable impacts. Firstly, it led to an increased referral rate (p < 0.05) and a reduced duration to surgery (p < 0.05). During MVD, there was a significant increase in the identification of complex compression (p < 0.05) and a reduced frequency of internal neurolysis (p < 0.05). After surgery, the single-surgeon group exhibited a superior pain-control profile (RR 1.9, p < 0.001; ARR 26–36%), higher pain-free survival rate (p < 0.001), lower likelihood of pain recurrence (HR 0.2, p < 0.0001), and fewer additional surgical interventions compared to the multi-surgeon group. Moreover, the involvement of residents did not significantly impact surgical outcomes. Implementing a single-surgeon policy for MVD in LMICs has the potential to improve surgical outcomes, provide social benefits, and offer educational opportunities. [ABSTRACT FROM AUTHOR]

• Single-surgeon MVD for TN resulted in significantly higher costs. • Despite higher costs, more pain-and-complication-specific QALYs were gained. • ICER shows single-surgeon MVD for TN is highly cost-effective by WHO standards. Centralizing surgical cases to a dedicated surgeon (single-surgeon approach) has shown improved outcomes in various neurosurgical procedures, including microvascular decompression (MVD) for trigeminal neuralgia (TN). However, the cost-effectiveness of this approach in MVD for TN has not been conclusively demonstrated. This study aims to investigate the cost-effectiveness of the single-surgeon approach in MVD for TN compared to the conventional multi-surgeon approach. A prospective cohort study was conducted from 2014 to 2020 (multi-surgeon approach 2014–2017; single-surgeon approach 2018–2020). Data on demographic and clinical characteristics, pain control, complications, hospital length of stay, and costs from the healthcare provider's perspective (pre-operative, operative, post-operative, follow-up intervention, and complication-related) were documented. Pain-and-complication-specific quality-adjusted life years (PCQALY) were calculated using Kaplan-Meier favorable-pain-control and complication-free probability curves, followed by a cost-effectiveness analysis. Seventy-two patients were included (46 in the single-surgeon group, 26 in the multi-surgeon group). The single-surgeon approach yielded a higher 3-year PCQALY gain (2.8 vs. 1.6) and significantly shorter hospital stays (5.7 ± 3.5 days vs. 8.9 ± 3.9 days) despite higher total costs (USD 12,462 ± 5,577 vs. USD 9,128 ± 4,012) (p < 0.05). The single-surgeon approach had a cost-effectiveness ratio of USD 4,491/PCQALY (vs. USD 5,635/PCQALY for the multi-surgeon approach), with an Incremental Cost-Effectiveness Ratio (ICER) of USD 2,887/PCQALY gained (0.65 times GDP/capita), indicating its cost-effectiveness according to World Health Organization criteria. The single-surgeon approach is cost-effective despite its higher associated costs, due to its superior pain control and complication profile. [ABSTRACT FROM AUTHOR]