目的：门诊手术和当天出院正在发展与现代医疗保健不断变化的需求相一致的领域，通过降低患者对医院感染的易感性，血栓栓塞并发症,医疗错误。当与增强的手术后恢复方案配对时，他们有希望将某些接受颅骨手术的患者安全地过渡到门诊治疗。本研究旨在评估颅内肿瘤切除术和内镜下第三脑室造瘘术（ETV）后手术当天的出院情况，并探讨与麻醉方法的潜在关联。并发症,和再入院率。
方法：对计划在2020年8月至2023年10月手术当天计划出院的患者进行了回顾性分析。数据包括患者人口统计特征，术前临床缺陷，诊断,在术前和术后MRI上的发现，病变特征,并发症,和再入院率。
结果：共202例患者纳入研究。平均年龄为56.8岁，117名（57.9％）患者为女性。患者在手术前一天晚上入院，以获得术前清除并接受MRI检查。最常见的诊断是转移（23.3％），脑膜瘤(20.8%),胶质母细胞瘤（12.4%），低级别胶质瘤（10.4%）。开颅手术(46.5%),立体定向针吸活检（35.1），和ETV（6.9％）是最常见的程序。13例(6.4%)患者接受清醒开颅手术,189例(93.6%)外科手术在全身麻醉下进行.1.5%的患者出现并发症，在平均9.3个月的随访中没有观察到永久性并发症。总的来说,179例（88.6%）患者在手术当天成功出院。平均住院时间为26.8小时,术后住院时间中位数为7小时。23例（11.4%）患者在术后第0天被认为不适合出院，而是在术后第1天出院。这些延误的原因包括进一步的临床监测(n=12)，社会因素(n=4)，和患者偏好(n=7)。年龄与住院时间呈正相关(p=0.006)。总的来说,6.4%的患者在出院后1-30天内再次入院，2.5%的人再次进入神经外科。
结论：这项研究证明了手术当天出院的安全性和可行性，成功率高，并发症发生率低。早期出院不会增加发病率或再入院率。实施明确的出院协议和全面的患者教育对于神经外科手术中成功的当日出院计划至关重要。
OBJECTIVE: Outpatient surgery and same-day discharge are developing fields that align with the evolving needs of modern healthcare, presenting a notable advantage by reducing patient susceptibility to nosocomial infections, thromboembolic complications, and medical errors. When paired with enhanced recovery after surgery protocols, they hold promise in safely transitioning certain patients undergoing cranial surgery to outpatient care. This study aimed to evaluate discharge on the same day of surgery after intracranial tumor resection and endoscopic third ventriculostomy (ETV) and to investigate potential associations with anesthesia methods, complications, and readmission rates.
METHODS: A retrospective analysis of patients scheduled for planned discharge on the same day of surgery between August 2020 and October 2023 was conducted. Data included patient demographic characteristics, preoperative clinical deficits, diagnosis, findings on preoperative and postoperative MRI, lesion characteristics, complications, and readmission rates.
RESULTS: A total of 202 patients were included in the study. The mean age was 56.8 years and 117 (57.9%) patients were female. Patients were admitted the evening before surgery to obtain preoperative clearance and undergo MRI. The most common diagnoses were metastasis (23.3%), meningioma (20.8%), glioblastoma (12.4%), and low-grade glioma (10.4%). Craniotomy (46.5%), stereotactic needle biopsy (35.1), and ETV (6.9%) were the most common procedures performed. Thirteen (6.4%) patients underwent awake craniotomy, and 189 (93.6%) surgical procedures were conducted under general anesthesia. Complications occurred in 1.5% of patients, with no permanent complications observed during a mean follow-up of 9.3 months. In total, 179 (88.6%) patients were successfully discharged on the same day of surgery. The median length of hospitalization was 26.8 hours, with the median length of postoperative stay being 7 hours. Twenty-three (11.4%) patients were deemed ineligible for discharge on postoperative day 0 and instead discharged on postoperative day 1. The reasons for these delays included further clinical monitoring (n = 12), social factors (n = 4), and patient preference (n = 7). Age was positively correlated with length of hospitalization (p = 0.006). In total, 6.4% of patients were readmitted within 1-30 days after discharge, with 2.5% readmitted to the department of neurosurgery.
CONCLUSIONS: This study demonstrates the safety and feasibility of discharge on the same day of surgery, with a high success rate and low complication rates. Early discharge did not increase morbidity or readmission rates. Implementation of clear discharge protocols and thorough patient education are crucial for successful same-day discharge programs in neurosurgery.
