Introduction: Meningiomas account for approximately one-third of brain tumors. Median length of stay (LOS) is 5 days with total charges equaling approximately $55,000. Early rehabilitation improves the functional outcome for patients after surgery. The primary goal was to analyze LOS as a direct result of surgical date and to characterize the individual variables that may impact hospital course, early access to rehab, and long-term functional status.
Methods: A retrospective database was generated of meningioma patients who underwent elective surgical resection at our institution over a 3-year study period (2011-2014). Each record was evaluated for demographics,medical co-morbidities,day of surgery,LOS,physical therapy (PT) recommendations,tumor type,insurance status,complications,functional status,and 30-day readmission rates. Given national median LOS of 5 days, we subdivided into two cohorts: short LOS (<3days) and long LOS (greater or equal 3days) for subgroup analysis. Statistical analysis was performed using SPSS 21.0.
Results: We identified 140(25 male,115 female) patients. 71 had surgery during the early week (Monday-Wednesday) and 69 had surgery in later week (Thursday-Friday). Median age was 58 with median tumor diameter of 3.2 cm. 56% of patients had public insurance, and 44% had private with no variation between groups. PT recommendations for rehabilitation were 25% of early patients and 42% of late patients. Medical co-morbidities had a strong correlation with respective LOS (p<0.0001,Mann-Whitney test). The median LOS for the early and late populations was 3 and 4 days, respectively. There was a statistically significant short LOS (<3 days) in those patients who underwent surgery early versus those in the later week(p=0.045,Mann-Whitney test).
Conclusions: Day of surgery plays a significant role in LOS for meningioma patients. Clinicians should remain aware of factors that may delay optimal patient discharge and early access to rehabilitation facilities. Studies are needed to assess the social variables that may affect LOS and the clinical and financial implications for extended hospital courses.
Patient Care: To identify avenues to optimize surgery scheduling to ensure early access to rehabilitation and therefore decreased hospital stays.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) understand the importance of scheduling on early rehabilitation after meningioma surgery, 2) identify system-based approaches to decrease length of stay, 3) Develop strategies to gain early access to rehab, which lead to decreased length of stay and hospital costs