title: Day surgery craniotomy for unruptured cerebral aneurysms: a single center experience.
abstract: BACKGROUND
  Ambulatory day surgery is an evolving specialty in line with demands of modern medicine, health care services, and economics, but its role in neurovascular surgery remains controversial. The purpose of this study was to describe our experience of patients undergoing elective clipping of intact cerebral aneurysms as day surgery.
  
  
  METHODS
  This retrospective and prospective observational study was carried out as a cohort review of patients who underwent outpatient clipping of an intact intracranial aneurysm at the Toronto Western Hospital, University Health Network, between May 2009 and November 2012. Patients were categorized as success (discharged on the same day) or failure (requiring unplanned postoperative hospital admission) of day surgery. Data included the preoperative assessment of the patient, anesthetic management, postoperative care, and the incidence of perioperative complications. Outcomes were duration of hospital stay, and any problems preventing same-day discharge.
  
  
  RESULTS
  During the study period 25 patients aged 54±9 years underwent outpatient aneurysm repair. Seventeen patients (68%) successfully completed day surgery, and 8 patients (32%) were admitted to the hospital after surgery due to perioperative complications. Duration of hospital stay in the failure group ranged from 2 to 18 days.
  
  
  CONCLUSIONS
  Our data demonstrates that surgical clipping of unruptured cerebral aneurysms may be performed in an outpatient setting. Careful selection of day surgery candidates and postoperative assessment for complications is needed. Further research is needed to identify potential risk factors and to target patient subgroups for successful ambulatory surgery.
authors.affiliation: *Department of Anesthesia †Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Goettel
authors.forename: Jason
authors.initials: J
authors.lastname: Chui
authors.forename: Lashmi
authors.initials: L
authors.lastname: Venkatraghavan
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
authors.forename: Pirjo H
authors.initials: PH
authors.lastname: Manninen
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000758:Anesthesia; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000628:therapy; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome