A retrospective cohort-matched comparison of conscious sedation versus general anesthesia for supratentorial glioma resection. Clinical article.
OBJECTIVE
Glioma resection under conscious ("awake") sedation (CS) is used for eloquent areas of the brain to minimize postoperative neurological deficits. The objective of this study was to compare the duration of hospital stay, overall hospital cost, perioperative morbidity, and postoperative patient functional status in patients whose gliomas were resected using CS versus general endotracheal anesthesia (GEA).


METHODS
Twenty-two cases in 20 patients who underwent surgery for cerebral gliomas under CS and a matched cohort of 22 cases in 19 patients who underwent surgery under GEA over a 3-year period were retrospectively evaluated. Criteria for inclusion in the study were as follows: 1) a single cerebral lesion; 2) gross-total resection as evidenced by postoperative Gd-enhanced MR imaging within 48 hours of surgery; 3) a WHO Grade II, III, or IV glioma; 4) a supratentorial lesion location; 5) a Karnofsky Performance Scale score ≥ 70; 6) an operation performed by the same neurosurgeon; and 7) an elective procedure.


RESULTS
The average hospital stay was significantly different between the 2 groups: 3.5 days for patients who underwent CS and 4.6 days for those who underwent GEA. This result translated into a significant decrease in the average inpatient cost after intensive care unit (ICU) care for the CS group compared with the GEA group. Other variables were not significantly different.


CONCLUSIONS
Patients undergoing glioma resection using CS techniques have a significantly shorter hospital stay with reduced inpatient hospital expenses after postoperative ICU care.
Peruzzi
Pierpaolo
P
Department of Neurological Surgery, The Ohio State University College of Medicine, James Cancer Hospital, Columbus, Ohio, USA.
Bergese
Sergio D
SD
Viloria
Adolfo
A
Puente
Erika G
EG
Abdel-Rasoul
Mahmoud
M
Chiocca
E Antonio
EA
D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000191:economics; D000769:Anesthesia, Inhalation; D015331:Cohort Studies; D016292:Procedural Sedation / Q000191:economics; D003365:Costs and Cost Analysis; D003399:Craniotomy; D003422:Critical Care / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000191:economics / Q000209:etiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000191:economics / Q000534:rehabilitation; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome