Same-day discharge after craniotomy for brain tumor resection: enhancing patient selection through a prognostic scoring system

Author:

Levy Adam S.1,Merenzon Martin A.1,Bhatia Shovan1,Costello Meredith C.1,Di Long1,Lu Victor M.1,Morell Alexis A.1,Daggubati Lekhaj1,Shah Ashish H.12,Komotar Ricardo J.12,Ivan Michael E.12

Affiliation:

1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami; and

2. Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida

Abstract

OBJECTIVE Neurosurgery, among other surgical fields, is amid a shift in patient management with enhanced recovery and same-day discharge (SDD) protocols slowly becoming more popular and feasible. While such protocols reduce the risk of nosocomial complications and improve patient satisfaction, appropriate patient selection remains an area of debate. The authors aimed to better quantify selection criteria through a prospective follow-up study of patients undergoing brain tumor resection with SDD. METHODS Three arms of analysis were carried out. First, clinical data of SDD patients were prospectively collected between August 2021 and August 2022. In parallel, a retrospective analysis of patients who qualified for SDD but were excluded at surgeon clinical discretion over the same period was performed. Third, a comparative analysis of the pilot and follow-up studies was done from which a clinical scoring system for patient selection was derived. RESULTS Over the duration of the study, 31 of 334 patients were selected for SDD while 59 qualified for SDD by previously defined criteria but were not selected at the surgeon’s discretion. There was no difference in outcomes between the two groups, and there were no postoperative complications among the SDD group within 30 days of surgery. Preoperative clinical characteristics found to be significantly different between the two cohorts (left-sided lesion, extra-axial pathology, prior treatment of brain tumor, and tumor volume ≤ 11.75 cm3) were included in a predictive scoring system for successful SDD. The scoring system was found to significantly predict high or low likelihood for successful SDD when tested on the mixed prospective cohort. CONCLUSIONS This study provides a straightforward clinical scoring system for appropriate selection of candidates for SDD after craniotomy for brain tumor resection. This clinical tool aims to aid clinicians in appropriate admission course selection and builds on the growing literature surrounding same-day and outpatient cranial neurosurgery.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Neurology (clinical),General Medicine,Surgery

Reference26 articles.

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2. Same-day discharge after brain tumor resection: a prospective pilot study;Vallejo FA,2022

3. Infection prevention and enhanced recovery after surgery: a partnership for implementation of an evidence-based bundle to reduce colorectal surgical site infections;Albert H,2019

4. Outpatient brain tumor surgery: innovation in surgical neurooncology;Boulton M,2008

5. Day-case neurosurgery for brain tumours: the early United Kingdom experience;Grundy PL,2008

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