Outcomes of a care bundle strategy at a dedicated private surgical center for idiopathic normal pressure hydrocephalus
6 affiliations
- 1Machine Intelligence in Clinical Neuroscience (MICN) & Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- 2Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden
- 3Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 4Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- 5Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- 6Department of Medical Sciences, Örebro University, Örebro, Sweden
Abstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent and surgically treatable condition in the elderly. Ventriculoperitoneal (VP) shunting is the standard treatment, yet outcomes may vary depending on surgical expertise and care delivery models. This study evaluates outcomes of a care bundle strategy for iNPH at a private healthcare provider under public contract.
Methods: We performed a retrospective analysis of a prospectively collected cohort of consecutive patients undergoing VP shunt placement for iNPH at a private hospital between November 2024 and November 2025. All procedures were performed by two senior consultant neurosurgeons adhering to a care bundle strategy. Clinical outcomes and patient-reported experience measures (PREM) were assessed at one month postoperatively.
Results: Eighty patients were included, with 100% follow-up for clinical outcomes and 83% response (n = 60) to PREMs. Mean time from referral to surgery was 28.5 ± 15 days. Overall clinical status improved in 93% of patients, with a gait improvement in 88%, and improvement rates of 24% and 29% for continence and cognition, respectively. No reoperations were required within the timeframe of the study. Patient satisfaction was high across all domains, with a mean likelihood-to-recommend score of 9.8 ± 0.69.
Conclusion: VP shunt placement within a consultant-led care bundle pathway at a private surgical center was associated with high patient-reported efficacy, low complication and reoperation rates, and excellent patient satisfaction. These findings support the feasibility and safety of dedicated iNPH care bundle models outside traditional academic centers to improve timely access to treatment.
Related
- A Frailty-integrated Prognostic Prediction Tool for Long-term Outcomes after Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: Development and Prospective Validation
- Five Decades of Infusion Testing in Idiopathic Normal-Pressure Hydrocephalus: Resistance to CSF Outflow as a Biomarker in Search of a Gold Standard
- CSF drainage strategy and complication management of hydrocephalus
- Paired CSF and plasma metabolomics reveals a robust CSF-centered metabolic phenotype in idiopathic normal-pressure hydrocephalus: an exploratory case-control study
- Dedicated Upper Extremity Trauma List for Closed Distal Radius Fractures Improves Surgical Efficiency and Reduces Costs
BibTeX
@article{wilde2026outcomes,
title = {{Outcomes of a care bundle strategy at a dedicated private surgical center for idiopathic normal pressure hydrocephalus}},
author = {Daniel de Wilde and Victor E. Staartjes and Rafael Holmgren and Erik Edström and Adrian Elmi-Terander},
journal = {Acta Neurochirurgica},
year = {2026},
month = oct,
doi = {10.1007/s00701-026-07075-z},
url = {https://doi.org/10.1007/s00701-026-07075-z},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Outcomes of a care bundle strategy at a dedicated private surgical center for idiopathic normal pressure hydrocephalus
AU - Daniel de Wilde
AU - Victor E. Staartjes
AU - Rafael Holmgren
AU - Erik Edström
AU - Adrian Elmi-Terander
PY - 2026
DA - 2026/10/22
JO - Acta Neurochirurgica
DO - 10.1007/s00701-026-07075-z
UR - https://doi.org/10.1007/s00701-026-07075-z
AB - Background: Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent and surgically treatable condition in the elderly. Ventriculoperitoneal (VP) shunting is the standard treatment, yet outcomes may vary depending on surgical expertise and care delivery models. This study evaluates outcomes of a care bundle strategy for iNPH at a private healthcare provider under public contract. Methods: We performed a retrospective analysis of a prospectively collected cohort of consecutive patients undergoing VP shunt placement for iNPH at a private hospital between November 2024 and November 2025. All procedures were performed by two senior consultant neurosurgeons adhering to a care bundle strategy. Clinical outcomes and patient-reported experience measures (PREM) were assessed at one month postoperatively. Results: Eighty patients were included, with 100% follow-up for clinical outcomes and 83% response (n = 60) to PREMs. Mean time from referral to surgery was 28.5 ± 15 days. Overall clinical status improved in 93% of patients, with a gait improvement in 88%, and improvement rates of 24% and 29% for continence and cognition, respectively. No reoperations were required within the timeframe of the study. Patient satisfaction was high across all domains, with a mean likelihood-to-recommend score of 9.8 ± 0.69. Conclusion: VP shunt placement within a consultant-led care bundle pathway at a private surgical center was associated with high patient-reported efficacy, low complication and reoperation rates, and excellent patient satisfaction. These findings support the feasibility and safety of dedicated iNPH care bundle models outside traditional academic centers to improve timely access to treatment.
SN - 0001-6268
SN - 0942-0940
ER -