Outpatient brain tumor craniotomy under general anesthesia

Outpatient brain tumor craniotomy under general anesthesia
Journal of Neurosurgery Posted online on March 4, 2016.

1Division of Neurosurgery, and 2Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
ABBREVIATIONS DSU = day surgery unit.

INCLUDE WHEN CITING Published online March 4, 2016; DOI: 10.3171/2015.11.JNS152151.

Correspondence Mark Bernstein, West Wing 4W-451, Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada. email: .

Abstract

OBJECTIVE

Outpatient craniotomy has many advantages to the psychological and physical well-being of patients, as well as benefits to the health care system. Its efficacy and safety have been well demonstrated, but barriers to its widespread adoption remain. Among the challenges is a perception that its application is limited to cases performed under conscious sedation, which is not always feasible given certain patient or surgeon factors. The object of this study was to characterize the rate of patient discharge from the day surgery unit (DSU) following craniotomy for tumor resection in a patient under general anesthesia. The authors identify postoperative complications and discuss appropriate patient selection for day surgery craniotomy.

METHODS

Patients undergoing elective craniotomy for supratentorial tumors between January 2010 and June 2014 were prospectively considered for outpatient management. Authors of the present study performed a retrospective chart review of these patients, analyzing cases by intention to treat.

RESULTS

Of 318 craniotomies undertaken in the study period, 141 were performed with the patient under general anesthesia. The day surgery protocol was initiated in 44 cases and completed in 38 (86%). Five patients required admission from the DSU, and 1 was discharged but admitted within the 1st postoperative day. In-hospital medical complications were fewer in the outpatient group, and no patients experienced an adverse outcome due to early discharge.

CONCLUSIONS

Close clinical and imaging surveillance in the early postoperative period allows for safe discharge of patients following craniotomy for tumor resection performed under general anesthesia. Therefore, general anesthesia does not preclude the application of outpatient craniotomy.

READ MORE:  http://thejns.org/doi/abs/10.3171/2015.11.JNS152151

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