Abstract：
BACKGROUND: Traditionally, patients undergoing craniotomy were subject to extended hospital stays for intensive monitoring and management of potential complications. However, with the evolution of surgical methods, anesthesia, and postoperative protocols, the feasibility and interest in same-day discharge (SDD) are growing. This study aimed to evaluate whether same-day discharge is a safe and feasible approach in craniotomy through a meta-analysis of the available literature.
METHODS: Following PRISMA guidelines, a comprehensive search was conducted across Medline, Embase, Cochrane, and Web of Science databases from inception to December 2023. Eligible studies comprised reports in English with a minimum of 4 patients who underwent craniotomies and were discharged with same-day discharge, whether single-arm or comparative with normal discharge. Single proportion analysis with 95 % confidence interval (CI) was used to pool the studies and Odds Ratio (OR) with 95 % CI was used to measure effects in comparative analysis. A random-effects model was adopted. Endpoints included success and failure of pre-planned same-day discharge, and postoperative complications throughout the hospital stay (until discharge), these complications were further categorized into major and minor complications. Also, need for reoperation, readmission within 24 h, readmission after 24 h, and mortality.
RESULTS: Seven observational studies were included. Five studies were included in the single-arm analysis, comprising data from 715 patients. Four studies comprising 731 patients were included in the comparative analysis, of whom 233 were discharged on SDD, and 498 were discharged normally. The analysis revealed a success rate of 88 % (95 % CI, 83 %-94 %), readmission to the hospital within the initial 24 h rate of 2 % (95 % CI, 1 %-2 %), readmission after 24 h rate of 1 % (95 % CI, 0 %-2 %;), total postoperative complications until discharge rate of 2 % (95 % CI, 1 %-4 %), major complications rate of 0 % (95 % CI, 0 %-0 %), minor complications rate of 2 % (95 % CI, 1 %-4 %), and mortality rate of 0 % (95 % CI, 0 %-0 %). Comparative analysis for complications and mortality showed no difference between both approaches.
CONCLUSIONS: This systematic review and meta-analysis identified that same-day discharge in craniotomy for selected patients, as well as for tumor resection craniotomies, is highly feasible and safe, with a high success rate, low failure, and reoperation rates. Moreover, for selected patients, no evidence of harm in same-day discharge was identified when compared with normal discharge. Consequently, same-day discharge may be considered a viable option, provided appropriate selection criteria are employed.
METHODS: Following PRISMA guidelines, a comprehensive search was conducted across Medline, Embase, Cochrane, and Web of Science databases from inception to December 2023. Eligible studies comprised reports in English with a minimum of 4 patients who underwent craniotomies and were discharged with same-day discharge, whether single-arm or comparative with normal discharge. Single proportion analysis with 95 % confidence interval (CI) was used to pool the studies and Odds Ratio (OR) with 95 % CI was used to measure effects in comparative analysis. A random-effects model was adopted. Endpoints included success and failure of pre-planned same-day discharge, and postoperative complications throughout the hospital stay (until discharge), these complications were further categorized into major and minor complications. Also, need for reoperation, readmission within 24 h, readmission after 24 h, and mortality.
RESULTS: Seven observational studies were included. Five studies were included in the single-arm analysis, comprising data from 715 patients. Four studies comprising 731 patients were included in the comparative analysis, of whom 233 were discharged on SDD, and 498 were discharged normally. The analysis revealed a success rate of 88 % (95 % CI, 83 %-94 %), readmission to the hospital within the initial 24 h rate of 2 % (95 % CI, 1 %-2 %), readmission after 24 h rate of 1 % (95 % CI, 0 %-2 %;), total postoperative complications until discharge rate of 2 % (95 % CI, 1 %-4 %), major complications rate of 0 % (95 % CI, 0 %-0 %), minor complications rate of 2 % (95 % CI, 1 %-4 %), and mortality rate of 0 % (95 % CI, 0 %-0 %). Comparative analysis for complications and mortality showed no difference between both approaches.
CONCLUSIONS: This systematic review and meta-analysis identified that same-day discharge in craniotomy for selected patients, as well as for tumor resection craniotomies, is highly feasible and safe, with a high success rate, low failure, and reoperation rates. Moreover, for selected patients, no evidence of harm in same-day discharge was identified when compared with normal discharge. Consequently, same-day discharge may be considered a viable option, provided appropriate selection criteria are employed.
摘要：
背景：传统上，接受开颅手术的患者需要延长住院时间,以加强对潜在并发症的监测和管理.然而,随着手术方法的发展，麻醉,和术后协议，对当日放电(SDD)的可行性和兴趣正在增长。本研究旨在通过对现有文献的荟萃分析，评估当日出院在开颅手术中是否是安全可行的方法。
方法：遵循PRISMA指南，在Medline进行了全面搜索，Embase,科克伦,和WebofScience数据库从成立到2023年12月。符合条件的研究包括英文报告，其中至少有4名患者接受了开颅手术，并在当天出院。无论是单臂还是与正常放电相比。使用具有95％置信区间（CI）的单一比例分析来汇总研究，并使用具有95％CI的比率（OR）来衡量比较分析中的效果。采用随机效应模型。终点包括预先计划的当天出院的成功和失败，和术后并发症在整个住院期间（直到出院），这些并发症进一步分为主要和次要并发症.此外，需要再次手术，24小时内再入院，24小时后再入院，和死亡率。
结果：纳入7项观察性研究。单臂分析包括五项研究，包括来自715名患者的数据。包括731名患者的四项研究被纳入比较分析，其中233人在SDD上出院，498人正常出院。分析显示成功率为88%(95%CI，83%-94%)，最初24小时内再次入院率为2%(95%CI，1%-2%)，24小时后再入院率为1%(95%CI，0%-2%；)，术后总并发症发生率为2%(95%CI,1%-4%),主要并发症发生率为0%（95%CI，0%-0%），轻微并发症发生率为2%（95%CI，1%-4%），死亡率为0%(95%CI,0%-0%)。并发症和死亡率的比较分析显示两种方法之间没有差异。
结论：这项系统评价和荟萃分析确定，选定患者开颅手术当天出院，以及肿瘤切除开颅手术，是高度可行和安全的，成功率很高，低故障,和再操作率。此外，对于选定的患者，与正常出院相比,没有发现当天出院时的损害证据.因此,当天出院可能被认为是一个可行的选择，只要采用适当的选择标准。
方法：遵循PRISMA指南，在Medline进行了全面搜索，Embase,科克伦,和WebofScience数据库从成立到2023年12月。符合条件的研究包括英文报告，其中至少有4名患者接受了开颅手术，并在当天出院。无论是单臂还是与正常放电相比。使用具有95％置信区间（CI）的单一比例分析来汇总研究，并使用具有95％CI的比率（OR）来衡量比较分析中的效果。采用随机效应模型。终点包括预先计划的当天出院的成功和失败，和术后并发症在整个住院期间（直到出院），这些并发症进一步分为主要和次要并发症.此外，需要再次手术，24小时内再入院，24小时后再入院，和死亡率。
结果：纳入7项观察性研究。单臂分析包括五项研究，包括来自715名患者的数据。包括731名患者的四项研究被纳入比较分析，其中233人在SDD上出院，498人正常出院。分析显示成功率为88%(95%CI，83%-94%)，最初24小时内再次入院率为2%(95%CI，1%-2%)，24小时后再入院率为1%(95%CI，0%-2%；)，术后总并发症发生率为2%(95%CI,1%-4%),主要并发症发生率为0%（95%CI，0%-0%），轻微并发症发生率为2%（95%CI，1%-4%），死亡率为0%(95%CI,0%-0%)。并发症和死亡率的比较分析显示两种方法之间没有差异。
结论：这项系统评价和荟萃分析确定，选定患者开颅手术当天出院，以及肿瘤切除开颅手术，是高度可行和安全的，成功率很高，低故障,和再操作率。此外，对于选定的患者，与正常出院相比,没有发现当天出院时的损害证据.因此,当天出院可能被认为是一个可行的选择，只要采用适当的选择标准。
