Same-day discharge after brain tumor resection: a prospective pilot study

Abstract

Purpose Outpatient brain surgery has many advantages for the psychological and physical wellbeing of patients, as well as reduced costs to the health care system. Compared with inpatient admissions, same day discharges reduce patient exposure to nosocomial infection, thromboembolic complications, and medical error. We aim to establish a prospectively collected quality outcomes database to examine the outcomes of patients that undergo brain tumor resection and are discharged home the same day as surgery. Methods We have established a prospectively collected quality outcomes database to examine the outcomes of all patients that underwent brain tumor resection by a single neurosurgeon (R.J.K) at our institution from August 2020 to August 2021 and were discharged home the same day as surgery. Results Over the one-year period this study was conducted, 37 of 334 patients met inclusion criteria for the outpatient protocol. Thirty-two patients were discharged on the same day as surgery. Five patients (14%) were considered eligible for outpatient surgery but were ultimately admitted to the hospital postoperatively and were discharged after an overnight observation. No postoperative complications were noted at two-week postoperative follow-up. Conclusion In select patients undergoing brain tumor surgery, same day discharge should be considered. Establishing a multidisciplinary team of physicians, nurses, radiologists, and physical therapists is critical to achieving this aim. Physicians should have a low threshold to admit a patient with concerning exam findings, complications, or complicated past medical history. Once discharged, open communication with the patient and their family is critical to detect complications that should trigger rehospitalization and intervention.

Awake Craniotomy Program Implementation

“…As health care costs increase in developed nations, particularly in the US, there is an increasing focus on strategies that maintain or improve patient outcomes while being economically efficient . In neurosurgery, and brain tumor surgery in particular, multiple centers have reported their experience decreasing mean LOS and achieving same-day discharge . But progress to reduce mean LOS for awake craniotomy lags behind other surgical specialties.…”

“…Concerns regarding short-term risk of deterioration after same-day discharge have prevented a wider adoption of standards and practices aimed at same-day craniotomies and faster discharge times. Regardless, multiple centers have attempted to change their practices to enable same-day discharge . Recently, Vallejo et al reported on the implementation of an outpatient craniotomy program applicable to 37 of 334 patients undergoing craniotomy, with successful same-day discharge in 32 patients.…”

“…[8][9][10][11][12] Reduced LOS lowers exposure to potential nosocomial infections and thromboembolic complications, alleviates the psychological impact of brain tumor surgery, and is associated with higher patient satisfaction. 10,13,14 Same-day discharge for neurosurgical cases was initially reported on minimally invasive procedures or biopsies; however, more recent studies have described significant reductions in inpatient admission rates for patients undergoing more complex surgical procedures such as supratentorial tumor resections 8 and surgical clipping of intact cerebral aneurysms. 14 Awake craniotomy represents a promising strategy that not only can reduce LOS but also may be a cost-effective treatment option.…”

“…The evolution of neuro-oncological surgery has led to progressively reduced surgical morbidity and enhanced patient recovery as new technologies and protocols are implemented . In fact, updated neuroanesthesia protocols, improved neuromonitoring and neuronavigation, and implementation of new surgical adjuncts have resulted in a reduced length of stay (LOS) and, in some cases, same-day discharge . Reduced LOS lowers exposure to potential nosocomial infections and thromboembolic complications, alleviates the psychological impact of brain tumor surgery, and is associated with higher patient satisfaction .…”

Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery

“…Definitive guidelines are still lacking regarding patient selection criteria and perioperative protocol. We suggest a perioperative care pathway protocol for SDNS, adapted from multiple studies (Tables 1 and 2) [2–4,13,16,18 ▪▪ ,19 ▪ ,20 ▪ ,21,22,23 ▪ ]. Advanced perioperative management strategies, such as optimization of comorbidities, preoperative medical clearance, and close monitoring during the peri-operative period, are crucial in mitigating the risks associated with comorbidities in SDNS.…”