Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
Miller School of Medicine, University of Miami, Miami, Florida, USA.
World Neurosurg. 2019 Jun;126:e869-e877. doi: 10.1016/j.wneu.2019.03.004. Epub 2019 Mar 9.
Shorter hospital stays have been associated with decreased complication rates, fewer hospital-acquired infections, and lower costs. We evaluated an optimized treatment paradigm for patients undergoing craniotomy allowing for postoperative day 1 (POD1) discharge if the criteria were met. We compared the complication and readmission rates between the POD1 patients and those with longer stays, and examined the patient and surgical variables for predictors of POD1 discharge.
We performed a retrospective review of craniotomies performed for tumor from 2011 to 2015. Craniotomies for tumors were included, and laser ablations and biopsies were excluded.
A total 424 of patients were included, 132 (31%) of whom had been discharged on POD1. The mean length of stay was 6 days. The POD1 patients had had significantly better preoperative Karnofsky performance scale scores (P < 0.0001) and modified Rankin scale scores (P < 0.0001). Patient frailty, measured using the modified frailty index, was negatively predictive of POD1 discharge (P = 0.0183). Surgical factors predictive of early discharge were awake surgery (P < 0.0001) and supratentorial location (P < 0.0001). No POD1 patients experienced deep venous thrombosis (DVT), pulmonary embolus (PE), or urinary tract infections. However, of the patients with a length of stay >1 day, 4.4% and 2.7% developed DVT or PE (P = 0.0119) and urinary tract infections (P = 0.0202), respectively. Multivariate regression identified patient factors (male gender, low preoperative modified Rankin scale score), tumor factors (right-sided, supratentorial, smaller size), lower modified frailty index score, and operative factors (lack of a cerebrospinal fluid drain, awake surgery) as independent predictors of successful early discharge.
Patients with good functional status can be safely discharged on POD1 after tumor craniotomy if the appropriate postoperative criteria have been met. Patients with early discharge had lower 30-day readmission and DVT/PE rates, likely owing to better baseline health status.
住院时间缩短与并发症发生率降低、医院获得性感染减少和成本降低有关。我们评估了一种针对接受开颅手术患者的优化治疗模式，如果符合标准，可以在术后第 1 天（POD1）出院。我们比较了 POD1 患者和住院时间较长患者的并发症和再入院率，并检查了患者和手术变量，以预测 POD1 出院的可能性。
我们对 2011 年至 2015 年期间因肿瘤而行开颅手术的患者进行了回顾性研究。纳入的手术为肿瘤切除术，排除了激光消融和活检。
共纳入 424 例患者，其中 132 例（31%）在 POD1 出院。平均住院时间为 6 天。POD1 患者的术前 Karnofsky 表现量表评分（P<0.0001）和改良 Rankin 量表评分（P<0.0001）显著更好。使用改良衰弱指数衡量的患者脆弱性与 POD1 出院呈负相关（P=0.0183）。与早期出院相关的手术因素包括清醒手术（P<0.0001）和幕上位置（P<0.0001）。没有 POD1 患者发生深静脉血栓形成（DVT）、肺栓塞（PE）或尿路感染。然而，在住院时间超过 1 天的患者中，分别有 4.4%和 2.7%发生 DVT 或 PE（P=0.0119）和尿路感染（P=0.0202）。多变量回归确定了患者因素（男性、术前改良 Rankin 量表评分低）、肿瘤因素（右侧、幕上、较小尺寸）、较低的改良衰弱指数评分和手术因素（无脑脊液引流、清醒手术）是成功早期出院的独立预测因素。
如果符合适当的术后标准，功能状态良好的肿瘤开颅术后患者可以安全地在 POD1 出院。早期出院的患者 30 天内再入院和 DVT/PE 发生率较低，可能是由于基线健康状况较好。
