Fast Track Recovery Program After Endoscopic and Awake Intraparenchymal Brain Tumor Surgery.
BACKGROUND
There is an increasing drive to deliver a more efficient, cost-effective service leading to shorter stays in hospital. The advent of endoscopic and awake tumor surgery has reduced the morbidity associated with brain tumor resection, allowing patients to mobilize and be discharged earlier. Here, we present the outcomes from a single neurosurgical center in the United Kingdom on a fast track recovery program.


METHODS
All consecutive patients undergoing elective endoscopic (n = 65) or awake (n = 10) tumor resection over a 3-year period between 1 December 2011 and 31 January 2015, under a single surgeon, were recruited. Data regarding their length of stay and outcomes were prospectively collated and analyzed.


RESULTS
66.7% of patients could be discharged safely within 1 postoperative day. Of the patients who stayed longer, 76% had a prolonged stay because of either social reasons or failing occupational therapy assessments. Only 6 cases (24%) of prolonged hospital admission were for medical reasons. Patients discharged within 1 day were no more likely to develop postoperative complications compared with those staying for longer (18% vs. 28%; odds ratio, 0.56; 95% confidence interval, 0.18-1.75; P = 0.21). The readmission rates were identical in both groups (16%). The only factor significantly affecting length of stay was World Health Organization performance score, both pre- and postoperative.


CONCLUSIONS
An early discharge after endoscopic and awake craniotomy tumor resection is both safe and feasible for most patients and is not associated with increased postoperative morbidity. We recommend that all patients who have good baseline function be offered short stay surgery.
Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Ruichong
R
Ma
Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Laurent J
LJ
Livermore
Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: puneet.plaha@ouh.nhs.uk.
Puneet
P
Plaha
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D003399:Craniotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
Awake surgery; Brain tumor; Day case surgery; Early discharge; Endoscopy; Fast track recovery; Intraparenchymal; Length of stay; Short stay; Surgery