Advanced practice providers in pediatric neurosurgery: a single-institution analysis of clinical and surgical productivity

Abstract

Objective: Advanced practice providers (APPs) have experienced remarkable growth in surgical fields, collaborating closely with surgeons to optimize patient care. Although several specialties have evaluated the roles and safety of APPs in team-based care models, few studies have explored their impact on clinical and surgical productivity, especially in pediatric settings. This study aimed to evaluate the influence of enhanced APP utilization within the division of neurosurgery at a leading academic pediatric institution in the United States.

Methods: Productivity metrics were obtained from the Surgery Department Executive Committee annual reports from October 2011 to September 2023. Descriptive analyses were conducted to identify divisional trends in provider numbers, surgical and clinic volumes, total operating room (OR) hours, gross charges, and work relative value units.

Results: Since 2012, the division of neurosurgery has witnessed consistent growth in clinic encounters per APP and in overall clinic volume, peaking in 2023. The MD surgical conversion rate was lowest in 2016 (1 OR case for every 6.39 encounters) and peaked in 2019 (1 OR case for every 3.57 encounters). Financial metrics, adjusted for inflation, demonstrated notable increases in work relative value units and gross charges over the decade.

Conclusions: Increased utilization and autonomy of APPs within the division of neurosurgery have facilitated greater procedural productivity and access to patient care. This study emphasizes the importance of integrating well-trained APPs into patient care models, allowing them to leverage their full expertise and training, particularly in pediatric surgical settings.

Keywords: advanced practice providers; neurosurgery; pediatric; productivity.