Digital Health Safety and Effacious Discussion Assignment

tumor diameter of 3.2 cm. Fifty-six percent of patients had public insurance, and 44% had private with no variation between groups. PT recommenda- tions for rehabilitation were 25% of early patients and 42% of late patients. Medical comorbidities had a strong correlation with respective LOS (P , .0001, Mann-Whitney test). The median LOS for the early and late populations was 3 and 4 days, respectively. There was a statistically significant short LOS (,3 days) in those patients who underwent surgery early vs those in the later week (P ¼ .045, Mann-Whitney test).

CONCLUSION: Day of surgery plays a significant role in LOS for meningioma patients. Clinicians should remain aware of factors that may delay optimal patient discharge and early access to rehabilitation facilities. Studies are needed to assess the social variables that may affect LOS and the clinical and financial implications for extended hospital courses.

151 The Impact of the 2006 Massachusetts Healthcare Reform on Neurosurgical Procedures and Patient Insurance Status

Nicolas W. Villelli, MD; Rohit Das, Hong Yan, Jian Zou, Nicholas M. Barbaro, MD

INTRODUCTION: The Massachusetts Healthcare Policy of 2006 has many similarities to the Affordable Care Act (ACA). There are concerns the ACA will negatively impact case volume and reimbursement for physicians. Analyzing neurosurgical cases and patient insurance status before and after the Massachusetts policy change can provide insight into the future of neurosurgery in the American health care system.

METHODS: The Massachusetts State Inpatient Database, which provides demographic information on hospital discharges, was studied for all neurosurgical International Classification of Diseases, Ninth Revision (ICD-9) procedure codes from 2001 to 2012. Four categories of ICD-9 codes were created: Tumor, Other Cranial/Vascular, Shunts, and Spine. A comparison of case totals and uninsured cases, before and after the policy change, was performed. Data from New York were used as a control.

RESULTS: After 2008, there was a decrease in uninsured cases in all 4 categories in Massachusetts. The number of cases for Tumor and Spine were unchanged, while Other Cranial/Vascular increased. Shunt totals decreased postpolicy, but exhibited a similar trend to the control. ForNew York, Spine case total and uninsured case volume increased, while Other Cranial/Vascular case totals decreased.

CONCLUSION: After the Massachusetts Healthcare Reform, the number of uninsured individuals undergoing surgeries significantly decreased for all categories of neurosurgical procedures, but more importantly, the total number of cases did not change dramatically. To the extent that Massachusetts predicts the overall US experience, some aspects of reimbursement may be positively impacted by the ACA. Neurosurgery, which treats patients with more urgent conditions, may be affected differently than other specialties.

152 Remote, Continuous Monitoring of Patient Mobility After Discharge: A Marker for 30-Day Readmission

Blake Eaton Samuel Taylor, BA; Trae Robison, Eric Lo, BS; Kyle McCormick, BA; Eliza M. Bruce, BA; Geoffrey Appelboom, MD; E. Sander Connolly, MD

INTRODUCTION: Early unplanned readmission is a major source of avoidable morbidity, mortality, and health care expenditure. In neurosurgery, 30-day readmissions are most often due to complica- tions, the majority of which are associated with a decrease in physical activity. Wearable, commercially available motion sensors measure movements over time and transmit these data wirelessly via a smart- phone application. These novel devices have the potential to objectively monitor patient recovery and capture complications and resulting readmissions as a single end point of activity. We sought to explore patient mobility patterns after discharge and their relationship to readmission.

METHODS: Patients with a smartphone (eg, iPhone, Android) were recruited postoperatively before hospital discharge. Each was given a FitBit ZipTM (FitBit Inc., San Francisco, California) (Table 1), a motion sensor whose accuracy we have previously validated. After syncing with patients’ smartphones via Bluetooth, subjects were instructed to wear the FitBit clipped to their socks (Figure A). The number of daily steps recorded, a well-recognized surrogate of physical activity, was then monitored remotely for 30 days after discharge.

RESULTS: Of the 23 patients enrolled, 4 were readmitted. Somewhat surprisingly, we observed that the integrity of the data wasmore associated with readmission than any particular pattern of physical activity pattern (Table 2). There were no readmissions among patients with complete data (Figure B), and an 11% readmission rate (expected in neurosurgery) among those with no data. However, subjects with either intermittent data, or data that were complete for the initial 5 days but subsequently became incomplete, had 2- and 4-fold the incidence of readmission (Figure C).

CONCLUSION: Mobility sensors may be used to track patient recovery after discharge, and are scalable to a large patient population. Incomplete data may indicate poorer health status or poor compliance with wearing the device. Consistent with emerging data from others, poor compliance itself may indicate a higher risk of readmission. Our future efforts will aim to target patients at high risk of readmission and develop appropriate interventions.

153 Hacking Neurosurgical Skills Training: Resident Education on the Cheap

Jason E. Blatt, MD; Rebecca Breese, BS; Edward Yap, MD; Wes Northam, MD; Joshua E. Loewenstein, MD

INTRODUCTION: A constant conundrum for the surgical educator is the balancing act between resident training and patient safety. Surgical simulators have become attractive, allowing trainees to practice emerging skills without risking patient health. However, many surgical simulators are expensive, complex, and frequently do not offer realistic tissue or instrument manipulation. Residents typically understand the steps and anatomy of a procedure long before they develop the manual skills to perform the operation gracefully. It would therefore be valuable to develop simple surgical simulators that offer decreased complexity and faithfully reproduce the haptic experience of a given procedure.

METHODS: The North Carolina Eye Bank Surgical Skills laboratory is a surgical educational facility operated by the University of North

CNS ORAL PRESENTATIONS

CLINICAL NEUROSURGERY VOLUME 62 | NUMBER 1 | AUGUST 2015 | 215

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