Introduction: A shift in neurosurgery is underway to transition relatively safe routine surgeries from inpatient to outpatient operations. Many of these surgeries are now performed at ambulatory surgery centers (ASC). This trend has begun to include select intracranial procedures. We believe that endoscopic procedures including cyst fenestration and third ventriculostomy make ideal intracranial procedures for an ASC. We present the first data on neuro-endoscopy performed outside of the hospital with direct comparison to an in-hospital cohort.
Methods: We performed a retrospective chart review of all elective neuro-endoscopy cases performed between January, 2014 and September, 2017 at a single ASC as well as those performed at its affiliated hospital. Data obtained for quantitative comparison included patient age, length of stay, clinical outcome and short term follow up of any medical complications.
Results: Number of endoscopic operations was 16 at the ASC vs 36 in-hospital with patient age range of 9 to 57 years (median 26.5 years) and 5 months to 54 years (median 5 years) respectively. Median time from start of surgery to discharge for the ASC and hospital cohorts was 3.5 hours (range 1.5 to 16) and 20.6 hours (range 2 to 56) respectively. There were no acute surgical or anesthetic complications in either cohort. Among the ASC cohort, no patient required hospital admission post-operatively, however two patients did present to an emergency department on post-operative day 1 with complaint of headache, but did not require admission. Surgical success rates and freedom from shunt at last follow up were equivalent at 75% for both cohorts.
Conclusions: Neuro-endoscopic procedures may be performed at an ASC with similar safety, efficacy and significantly shorter length stay as those done in a hospital. The transition of these operations to the outpatient setting would be expected to result in decrease in hospital-associated complications as well as overall surgical cost.
Patient Care: Transitioning appropriate surgeries out of the hospital setting will cut patient cost, decrease hospital-associated complications, and help to diminish the psychological stress of undergoing intracranial procedures.
Learning Objectives: By the conclusion of this session participants should be able to: 1) describe the benefits of operations performed at an ambulatory surgery center, 2) compare the length of stay for in-hospital neuro-endoscopy to that done at an ambulatory surgery center, 3) recognize a new neurosurgical procedure with potential to be performed out of hospital