Patient experience and satisfaction with awake craniotomy for brain tumours

Abstract

Awake craniotomy is increasingly used to facilitate safe maximal resection of brain tumours. Very little published data is available to determine patient experiences and satisfaction. This knowledge may lead to improvement in technique and enhance future patient care. In 2006, we began to use conscious sedation ('full awake technique') for craniotomies for tumour resection. A questionnaire designed with reference to Royal College of Surgeons (RCS) guidelines was sent out to 60 consecutive patients. Four areas of care were explored. These included the out-patient consultation with the neurosurgeon, anaesthetic consultation, operation and the post-operative period. Fourty-five responses were received. Ninety-three percent of the patients in our study felt involved sufficiently in the decision for awake surgery and felt they were given enough information when seen in the surgical consultation. However, only 64% of patients received written information in advance of their surgical date. Ninety-one percent of patients were confident that they would be looked after during surgery following their anaesthetic consultation. Eighty-seven percent of patients felt at ease during surgery. Twenty-four percent experienced some discomfort during surgery, some of which was related to positioning of the patient rather than surgical technique. Fifty-six percent of our patients reported no post-operative pain. Eighty-four percent of patients were happy with timing of their discharge. Eighty percent felt well supported post-discharge. This study demonstrates high levels of patient satisfaction and provides surgeons with useful data for consenting patients. We identified no difference in levels of patient satisfaction comparing day-case patients with those admitted. We identified areas for improvement including provision of written information, enhancing post-discharge support and allowing more time for anaesthetic discussion before surgery.

“Imagine your neighbor mows the lawn”: a pilot study of psychological sequelae due to awake craniotomy

“…9,10,13,15,16 In a retrospective study from Leslie and Davidson, 10 5 (71%) of the 7 patients experiencing unexpected intraoperative awareness during general anesthesia fulfilled the criteria for PTSD at the time of their interview. Although it has been described that awake craniotomy is well tolerated by the majority of patients, 17,19,21 psychological sequelae in terms of PTSD symptoms related to such an unusual situation are still mainly unknown.…”

“…[3][4][5] Currently, only a small number of studies are available that have assessed patients' experiences and sensations during the surgical procedure. Wahab et al 17 studied patient satisfaction with an awake craniotomy procedure and reported that 24% of the patients experienced some discomfort during surgery, some of which was related to the intraoperative positioning of the patient, and 56% reported no postoperative pain. Whittle et al 19 reported significant intraoperative pain in 20% of the patients investigated and strong anxiety in 13%.…”

Anästhesiologisches Management zur Wachkraniotomie

“…Während des Eingriffs befindet sich der Patient in einer neuen Situation; die Umgebung und viele der Anwesenden sind ihm unbekannt. Er ist mit vielen unangenehmen Geräuschen wie dem Bohren und Fräsen zur Schädeleröffnung oder dem Saugen von Blut konfrontiert [14,34] …”

Improving Information Provision for Neurosurgical Patients: A Qualitative Study

“…Consequently, the provision of written information by neurosurgeons has been proposed by others 10 . Not unexpectedly, almost all patients thought that a written record of the consultation would be very helpful.…”

“…proposed, such as audio recording consultations 9 , providing written information to patients 10,11 , and physician recommended web sites 12,13 .…”