Predictors of Successful Discharge of Patients on Postoperative Day 1 After Craniotomy for Brain Tumor
Predictors of Successful Discharge of Patients on Postoperative Day 1 After Craniotomy for Brain Tumor
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DOI：
10.1016/j.wneu.2019.03.004
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发表时间：
2019-06-01
影响因子：
2
通讯作者：
Ivan, Michael
中科院分区：
文献类型：
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作者：
Richardson, Angela M.;McCarthy, David J.;Ivan, Michael
背景：较短的住院时间与并发症发生率降低、医院获得性感染减少和费用降低相关。我们评估了接受开颅手术的患者的最佳治疗模式，如果符合标准，允许术后第1天（POD 1）出院。我们比较了POD 1患者和住院时间较长的患者之间的并发症和再入院率，并检查了POD 1出院预测因素的患者和手术变量。方法：我们对2011年至2015年因肿瘤进行的开颅手术进行了回顾性分析。包括肿瘤开颅手术，激光消融和活检被排除在外。结果：共424例患者被纳入，其中132例（31%）已出院的POD 1。平均住院时间为6天。POD 1组患者术前Karnofsky评分（P < 0.0001）和改良兰金评分（P < 0.0001）均明显优于对照组。使用改良虚弱指数测量的患者虚弱对POD 1放电具有负面预测作用（P = 0.0183）。预测早期出院的手术因素是清醒手术（P < 0.0001）和幕上位置（P < 0.0001）。没有POD 1患者发生深静脉血栓形成（DVT）、肺栓塞（PE）或尿路感染。然而，在住院时间>1天的患者中，分别有4.4%和2.7%的患者发生DVT或PE（P = 0.0119）和尿路感染（P = 0.0202）。多变量回归确定患者因素（男性，术前改良兰金量表评分低），肿瘤因素（右侧、幕上、较小尺寸）、改良虚弱指数评分较低和手术因素（缺乏脑脊液引流，清醒手术）作为早期成功出院的独立预测因素。如果符合适当的术后标准，功能状态良好的患者可以在肿瘤开颅术后第1天安全出院。早期出院的患者30天再入院率和DVT/PE发生率较低，可能是由于基线健康状况较好。
BACKGROUND: Shorter hospital stays have been associated with decreased complication rates, fewer hospital-acquired infections, and lower costs. We evaluated an optimized treatment paradigm for patients undergoing craniotomy allowing for postoperative day 1 (POD1) discharge if the criteria were met. We compared the complication and readmission rates between the POD1 patients and those with longer stays, and examined the patient and surgical variables for predictors of POD1 discharge.METHODS: We performed a retrospective review of craniotomies performed for tumor from 2011 to 2015. Craniotomies for tumors were included, and laser ablations and biopsies were excluded.RESULTS: A total 424 of patients were included, 132 (31%) of whom had been discharged on POD1. The mean length of stay was 6 days. The POD1 patients had had significantly better preoperative Karnofsky performance scale scores (P < 0.0001) and modified Rankin scale scores (P < 0.0001). Patient frailty, measured using the modified frailty index, was negatively predictive of POD1 discharge (P = 0.0183). Surgical factors predictive of early discharge were awake surgery (P < 0.0001) and supratentorial location (P < 0.0001). No POD1 patients experienced deep venous thrombosis (DVT), pulmonary embolus (PE), or urinary tract infections. However, of the patients with a length of stay >1 day, 4.4% and 2.7% developed DVT or PE (P = 0.0119) and urinary tract infections (P = 0.0202), respectively. Multivariate regression identified patient factors (male gender, low preoperative modified Rankin scale score), tumor factors (right-sided, supratentorial, smaller size), lower modified frailty index score, and operative factors (lack of a cerebrospinal fluid drain, awake surgery) as independent predictors of successful early discharge.CONCLUSIONS: Patients with good functional status can be safely discharged on POD1 after tumor craniotomy if the appropriate postoperative criteria have been met. Patients with early discharge had lower 30-day readmission and DVT/PE rates, likely owing to better baseline health status.