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. 2024 Dec;40(12):4271-4278.
doi: 10.1007/s00381-024-06638-8. Epub 2024 Oct 5.

The pivotal role of neurosurgeons in transitional care: A comprehensive tertiary healthcare institution's experience

Zakir Chew  1   2 , Huiling Linda Lim  3   4 , Shakran Mahmood  4 , Srujana Vedicherla  3   4 , Miriam Santiago Kimpo  5 , Hian Tat Ong  6   7 , Vincent Dw Nga  3   8
Affiliations

The pivotal role of neurosurgeons in transitional care: A comprehensive tertiary healthcare institution's experience

Zakir Chew et al. Childs Nerv Syst. 2024 Dec.

Abstract

Purpose: Transitional care (TC) is increasingly crucial, particularly in neurosurgery, where optimal follow-through of patients' care is paramount. Challenges of transition are exacerbated by the complexity of neurosurgical conditions, with pediatric and adult neurosurgery often managed separately by different attending neurosurgeons or in different institutions. While numerous models for transitioning have been proposed, several barriers persist, impeding successful transfer from pediatric to adult settings. Our review focuses on important roles neurosurgeons can play in facilitating successful transition, exploring some existing TC models, with emphasis on the benefits of maintaining a single provider.

Methods: Clinic visits data between 2019 to 2023 of patients between the ages of 16 to 26 was compiled retrospectively. Successful transition was defined as continued follow-up moving from pediatric to adulthood with lost to follow-up being that of unsuccessful transition. Age, diagnosis and whether patients were successfully transitioned or lost to follow-up were documented.

Results: 1829 neurosurgical patients between the ages of 16 to 26 were identified over 5 years. A snapshot review identified 78 adolescent patients deemed to require follow-up into adulthood. 13 patients had epilepsy, 32 central nervous system (CNS) tumors, 17 congenital conditions, 14 neurovascular, and 2 patients had idiopathic intracranial hypertension. All 78 were noted to have successfully transited into their adulthood (age 21 and beyond). Having the same providers; having pediatric and adult neurosurgery within the same institution, was the single most important factor in facilitating successful transition.

Conclusion: Neurosurgeons in institutions, particularly those with experience and competencies in both pediatric and adult care, can serve as crucial anchors during the transitional period. At our institution, the implementation of this continuity of care model has demonstrated remarkable success. Institutions with both pediatric and adult services would be uniquely positioned to develop and implement effective transitional care.

Keywords: Pediatric neurosurgery; Tertiary healthcare; Transitional care.

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Conflict of interest statement

Declarations. Ethical approval: All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Consent for publication: Consent is given should the article be published. Conflict of interest: There was no conflict of interests among all authors. No financial or non-financial interests exist. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors declare no competing interests.

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