Timing of complications following stereotactic brain biopsy: implications for same-day discharge feasibility

PURPOSE: Protocols for postoperative complications and length of stay following stereotactic brain biopsy vary significantly across centers. We hypothesized that most complications occur early, indicating that same-day discharge may provide sufficient monitoring, potentially reduce costs, and optimize resource use. METHODS: We performed a retrospective chart review on adults undergoing brain biopsy at a single academic institution between August 2013 and March 2025. Post operative hemorrhages were identified and classified based on computed tomography imaging. Symptomatic complications were defined as any transient or permanent neurological deficits. Data were reported as median [IQR] for continuous variables and as frequency and proportion for categorical variables. RESULTS: The cohort included 200 patients (age 63 [51–72] years; 46% female, 70% White). Patients had a median Karnofsky Performance Status (KPS) score of 80 [70–90] and a median lesion size of 33 mm [22–45 mm]. Most lesions were subcortical (54.5%) and were neoplastic (84.5%). The complication rate was 13% and hemorrhage rate was 11%. The symptomatic complication rate was 5.5% and symptomatic hemorrhage rate was 2%. Among all complications, 34.6% occurred within the first hour and 76.9% within 6 h, with a median time to complication onset of 2 h [1–5.5 h]. 17% of patients had a 30-day readmission, with 15% of these cases due to biopsy-related causes. CONCLUSIONS: Stereotactic brain biopsy has low complication rates, with most complications occurring within the first 6 h postoperatively. This suggests that monitoring within this early period may be sufficient, potentially enabling same-day discharge, though future studies will need to validate these findings and establish formal frameworks for patient selection.