Post-operative day one discharge following craniotomy for tumour resection

Abstract

Post-operative admission following craniotomy for tumour resection (CTR) remains standard practice. To improve efficiency, optimise patient flow, and reduce length of stay (LOS), a post-operative day one (POD1) discharge pathway was implemented. This study evaluated the feasibility of POD1 discharge and identified factors associated with delayed discharge and 30-day unplanned readmission. A retrospective analysis of 263 consecutive patients undergoing CTR between November 2022 and December 2023 was performed. Baseline demographic, clinical, tumour-related, operative, and post-operative variables were collected. The primary outcome was POD1 discharge. Secondary outcomes included 30-day unplanned readmission and factors associated with discharge and readmission. Univariable logistic regression and Fisher’s exact test were used. POD1 discharge was achieved in 146 patients (55.5%). The overall 30-day unplanned readmission rate was 8.0%, including 7.5% among patients discharged on POD1. Mean cumulative 30-day hospital days were 1.0 days among patients discharged on POD1 compared with 7.0 days among patients requiring prolonged admission. POD1 discharge was not associated with increased odds of readmission (OR 0.87, 95% CI 0.35–2.17, p = 0.760). Diabetes mellitus (OR 0.41, 95% CI 0.17–0.96, p = 0.044), post-operative adverse events (OR 0.18, 95% CI 0.06–0.47, p = 0.001), and post-operative neurological deficits (OR 0.05, 95% CI 0.01–0.17, p < 0.001) were associated with reduced odds of POD1 discharge. Eloquent tumour location was associated with increased odds of readmission (OR 3.35, 95% CI 1.36–8.78, p = 0.010). POD1 discharge following CTR was feasible in more than half of patients and was not associated with increased 30-day readmission. These findings support structured POD1 discharge pathways in appropriately selected patients.