Introduction: A steady trend in medicine has been discharging patients earlier after surgical procedures, a trend which has been resisted by many in the field of intracranial tumor surgery. Here we demonstrate the feasibility of an aggressive discharge strategy on postoperative days 1 or 2 for patients undergoing elective intracranial surgery
Methods: We conducted a retrospective analysis on all patients undergoing elective intracranial keyhole surgery for tumors, cysts, and other masses discharged on postoperative day 1 or 2 between January 2010 and December 2011. Patients were informed preoperatively of plans for discharge on postoperative day 1 or 2. For those meeting discharge criteria, we suggested they continue recovery at home and allowed the patients to decide.
Results: Of 213 patients, 81.6% had supratentorial lesions, 16.9% had infratentorial lesions, and 1.4% had lesions extending above and below the tentorium. High grade gliomas accounted for 38.5% of lesions. No deaths or readmissions for postoperative swelling or hematomas occurred within 28 days of surgery. Overall rate of patients who required readmission for postoperative complications was 4.2%. Readmission rate for repeat surgery addressing complications causing neurologic symptoms was 1.9%.
Conclusions: Our data suggest that the most serious complications occur within hours of the procedure, not days. The complications requiring readmission that we observed would not have been avoided with longer inpatient courses. Thus, consideration should be given to sending well-looking patients home to recover on postoperative days 1 or 2.
Patient Care: Knowledge regarding the feasibility of early discharge after brain tumor surgery will prevent unnecessarily prolonged hospital courses for precaution only.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Discuss the pros and cons of early patient discharge.