Early Discharge After Surgery for Intra-Axial Brain Tumors

A steady trend in medicine has been discharging patients earlier after surgical procedures, a trend that has been resisted by many in the field of intracranial tumor surgery. Here we demonstrate the feasibility of discharge on postoperative days 1 or 2 for patients undergoing elective intracranial surgery.

We conducted a retrospective analysis on all patients undergoing elective intracranial keyhole surgery for tumors, cysts, and other masses between January 2010 and December 2011. During this time period, we used an early discharge plan centered on the clinical appearance of the patient, for which all patients were eligible preoperatively. Patients who met discharge criteria were encouraged to continue recovery at home.

Of 313 patients, 213 (68.1%) were discharged on postoperative days 1 or 2. Within this group, 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. The overall rate of readmission for postoperative complications was 4.2%, compared with 4.0% for patients discharged on or after postoperative day 3. Readmission rate for repeat surgery addressing complications causing neurological symptoms was 1.9%.

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.