Background: A daily algorithm for hospital discharge (DAHD) is a key point in the concept of Enhanced Recovery After Surgery (ERAS) protocol. We aimed to evaluate the length of stay (LOS), rate of complications, and hospital costs variances after the introduction of the DAHD compared to the traditional postoperative management of brain tumour patients. Methods: This is a cohort study with partial retrospective data collection. All consecutive patients who underwent brain tumour resection in 2017 were analysed. Demographics and procedure-related variables, as well as clinical outcomes, LOS and healthcare costs within 30 days after surgery were compared in patients before/pre-implementation and after/postimplementation the DAHD, which included: stable neurological examination; oral feeding without aspiration risk; pain control with oral medications; no intravenous medications. The algorithm was applied every morning and discharge was considered from day 1 after surgery if criteria was fulfilled. The primary outcome (LOS after surgery) analysis was adjusted for the preoperative performance status on a multivariable logistic regression model. Results: A total of 61 patients were studied (pre-implementation 32, post-implementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS decreased significantly (median 5 versus 3 days; p = 0.001) and the proportion of patients who were discharged on day 1 or 2 after surgery increased (44.8% vs 3.1%; p < 0.001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day followup were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group
INTRODUCTION
Until the 1990 s, perioperative care was based on empirical concepts and common practice, in part due to the paucity of scientific evidence. With the need of improving patient outcomes and reducing costs, the concern of developing safe and effective standards in postoperative care emerged. Recently, our institution has adopted a daily algorithm for hospital discharge (DAHD), which is a key point in the concept of Fast-Track Surgery. Thus, we designed a study to evaluate whether there was a difference in length of stay (LOS), rate of complications, and hospital costs after the introduction of the DAHD in the postoperative management of patients who underwent brain tumor resection.
METHODS
This is a retrospective cohort study. All consecutive patients who underwent brain tumor resection in 2017 by a single neurosurgeon were analyzed. Demographic and procedure-related variables, clinical outcomes, and healthcare costs within 30 d after surgery were collected and compared in patients before (preimplementation) and after (postimplementation) the daily algorithm for hospital discharge (DAHD).
RESULTS
About 61 patients who had been submitted to brain tumor resection were studied (preimplementation 32, postimplementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS after surgery in days decreased significantly (median 5 vs 3 days; P = .001). The proportion of patients who were discharged within day 1 or 2 after surgery was significantly higher after DAHD protocol (3.1% vs 44.8%; P < .001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, P = .043), mainly due to a reduction in median ward costs (US$922 vs US$1623, P = .009).
CONCLUSION
Early discharge after brain tumor surgery was safe, inexpensive, reduced the LOS, and hospitalization costs without increase in readmission rate or postoperative complications.
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