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07-07-2011 | Surgery | Article

Day surgery practicable for craniotomy, spinal decompression

Abstract

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MedWire News: Surgery for brain tumors or spinal decompression can be performed as day surgery without compromising patient safety, indicate the results of a large, single-center study.

"Although outpatient neurosurgery is not likely appropriate for all surgeons and centers, with rigorous adherence to patient safety, a select group can benefit from this alternative pathway," say Mark Bernstein (Toronto Western Hospital, Ontario, Canada) and co-workers.

But they caution: "Cases should be considered on an individual basis, and outpatient procedures should be presented as a well-informed option."

The study, which appears in the journal Neurosurgery, included 1003 patients who underwent neurosurgical procedures as outpatients between August 1996 and December 2009.

Overall, 96% of procedures were successfully performed as day surgery, while 4% resulted in hospital admission, and 0.6% of patients were admitted after being discharged home.

The largest group of patients, numbering 602, underwent spinal decompression. Of these patients, 97.3% were discharged home from the day surgery unit, 2.5% were admitted directly to hospital, and 0.2% were discharged but required later admission.

The corresponding rates for the 249 patients who underwent craniotomy for intra-axial supratentorial tumors were 92.8% for discharge, 5.2% for admission, and 2.0% for delayed admission.

A further 152 patients underwent image-guided brain biopsy, of whom 94.1% were successfully discharged, 4.6% were admitted, and 1.3% were discharged but later readmitted.

Overall, just two patients were admitted to hospital at their own request.

"This suggests that in those patients who did not require conversion to inpatient status for medical reasons, more than 99% were sufficiently satisfied with their postoperative state that they were comfortable leaving the hospital," say Bernstein et al.

"In fact, to many, the possibility of being discharged the same day as their operation made the disease and its management seem less serious," they add.

Reasons for admission in patients who were initially discharged home included congestive heart failure, intracerebral hemorrhage, and seizures. The researchers stress that the complication rate in their patients was similar to that in previous studies of inpatient surgery, and the readmission rate was also equivalent to that expected had the patients been kept in hospital overnight.

The team also notes that reduced hospital stays will "likely result in a reduction of nosocomial infections, thromboembolism, and medical error."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid

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