1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.
2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
J Neurosurg. 2024 Jul 12;141(6):1635-1643. doi: 10.3171/2024.4.JNS24504. Print 2024 Dec 1.
Outpatient surgery and same-day discharge are developing fields that align with the evolving needs of modern healthcare, presenting a notable advantage by reducing patient susceptibility to nosocomial infections, thromboembolic complications, and medical errors. When paired with enhanced recovery after surgery protocols, they hold promise in safely transitioning certain patients undergoing cranial surgery to outpatient care. This study aimed to evaluate discharge on the same day of surgery after intracranial tumor resection and endoscopic third ventriculostomy (ETV) and to investigate potential associations with anesthesia methods, complications, and readmission rates.
A retrospective analysis of patients scheduled for planned discharge on the same day of surgery between August 2020 and October 2023 was conducted. Data included patient demographic characteristics, preoperative clinical deficits, diagnosis, findings on preoperative and postoperative MRI, lesion characteristics, complications, and readmission rates.
A total of 202 patients were included in the study. The mean age was 56.8 years and 117 (57.9%) patients were female. Patients were admitted the evening before surgery to obtain preoperative clearance and undergo MRI. The most common diagnoses were metastasis (23.3%), meningioma (20.8%), glioblastoma (12.4%), and low-grade glioma (10.4%). Craniotomy (46.5%), stereotactic needle biopsy (35.1), and ETV (6.9%) were the most common procedures performed. Thirteen (6.4%) patients underwent awake craniotomy, and 189 (93.6%) surgical procedures were conducted under general anesthesia. Complications occurred in 1.5% of patients, with no permanent complications observed during a mean follow-up of 9.3 months. In total, 179 (88.6%) patients were successfully discharged on the same day of surgery. The median length of hospitalization was 26.8 hours, with the median length of postoperative stay being 7 hours. Twenty-three (11.4%) patients were deemed ineligible for discharge on postoperative day 0 and instead discharged on postoperative day 1. The reasons for these delays included further clinical monitoring (n = 12), social factors (n = 4), and patient preference (n = 7). Age was positively correlated with length of hospitalization (p = 0.006). In total, 6.4% of patients were readmitted within 1-30 days after discharge, with 2.5% readmitted to the department of neurosurgery.
This study demonstrates the safety and feasibility of discharge on the same day of surgery, with a high success rate and low complication rates. Early discharge did not increase morbidity or readmission rates. Implementation of clear discharge protocols and thorough patient education are crucial for successful same-day discharge programs in neurosurgery.
门诊手术和当日出院是现代医疗保健发展的领域，通过降低患者发生医院感染、血栓栓塞并发症和医疗错误的风险，具有显著优势。当与手术后强化康复方案相结合时，它们有望将接受颅部手术的某些患者安全过渡到门诊护理。本研究旨在评估颅内肿瘤切除和内镜第三脑室造瘘术（ETV）后当日出院的情况，并探讨与麻醉方法、并发症和再入院率的潜在关联。
对 2020 年 8 月至 2023 年 10 月期间计划当日出院的患者进行回顾性分析。数据包括患者人口统计学特征、术前临床缺陷、诊断、术前和术后 MRI 结果、病变特征、并发症和再入院率。
共纳入 202 例患者。平均年龄为 56.8 岁，117 例（57.9%）为女性。患者在手术前一天晚上入院，以获得术前检查并进行 MRI 检查。最常见的诊断是转移瘤（23.3%）、脑膜瘤（20.8%）、胶质母细胞瘤（12.4%）和低级别胶质瘤（10.4%）。最常见的手术方式为开颅术（46.5%）、立体定向活检（35.1%）和 ETV（6.9%）。13 例（6.4%）患者接受了清醒开颅术，189 例（93.6%）手术在全身麻醉下进行。1.5%的患者发生并发症，平均随访 9.3 个月未见永久性并发症。共有 179 例（88.6%）患者成功当日出院。住院中位数为 26.8 小时，术后住院中位数为 7 小时。23 例（11.4%）患者被认为不符合术后第 0 天出院标准，而改为术后第 1 天出院。这些延迟的原因包括进一步的临床监测（n=12）、社会因素（n=4）和患者意愿（n=7）。年龄与住院时间呈正相关（p=0.006）。共有 6.4%的患者在出院后 1-30 天内再次入院，其中 2.5%再次入住神经外科。
本研究表明，当日出院安全且可行，成功率高，并发症发生率低。早期出院并未增加发病率或再入院率。实施明确的出院方案和对患者进行全面的教育对于神经外科的成功当日出院计划至关重要。
