Outpatient Brain Tumor Surgery Feasible, Safe

Medscape
10 Jul, 2020 ,

As an ever-increasing number of complex surgeries are regularly being performed in an outpatient setting at ambulatory surgical centers, some brain tumor resections may be safe and feasible for appropriately selected patients, new research suggests. Unadjusted results from a large feasibility study that included more than 300 patients who underwent craniotomy for resection of meningioma showed that among those who were treated in an outpatient setting, mortality and complication rates were significantly lower than for their inpatient counterparts.

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As an ever-increasing number of complex surgeries are regularly being performed in an outpatient setting at ambulatory surgical centers, some brain tumor resections may be safe and feasible for appropriately selected patients, new research suggests.

Unadjusted results from a large feasibility study that included more than 300 patients who underwent craniotomy for resection of meningioma showed that among those who were treated in an outpatient setting, mortality and complication rates were significantly lower than for their inpatient counterparts.

Although adjusted analysis showed that between-group differences were no longer significant, outpatient surgery was still not associated with increased mortality or adverse events (AEs).

In addition, patients with low comorbidity rates appeared to be the group "most suitable for outpatient treatment," the investigators note.

"This is one of the first analyses using US data that shows that select neuro-oncology patients could benefit" from outpatient surgery, lead author Nikita Lakomkin, MD, Icahn School of Medicine, Mount Sinai Health System, New York City, told Medscape Medical News.

The study "has implications for patients, who often prefer to be treated close to home near their family, as well as reducing the overall cost of care," Lakomkin added.

The findings were presented at the virtual American Association of Neurological Surgeons (AANS) 2020 Annual Meeting.

Brain Surgery During COVID-19
Ambulatory surgical centers offer significant cost savings and convenience and have gained favor among clinicians and patients alike.

During the COVID-19 pandemic, services provided outside of hospitals confer the added benefit of potentially preventing hospital exposure to the virus.

Neurosurgery has already made its way to the centers, most notably in regard to spinal procedures.

Although neuro-oncology often involves highly complex operations better suited for the in-hospital setting, there are exceptions. For example, craniotomies for small cortical metastases are potential candidates for outpatient consideration, said Lakomkin.

"Neuro-oncology is an interesting field for this due to its incredible heterogeneity.

"People may think of really complex operations, but a lot are simpler. It is [important] to look at whether there is a subset of these patients who can benefit from the procedures," he added.

For the study, investigators evaluated data on 3671 adult patients in a prospective, multicenter surgical registry obtained from the American College of Surgeons. All the patients in the study underwent craniotomy for resection of meningioma with low- or high-grade glioma.

Of the participants, 148 (4%) had outpatient surgery. Patients with skull base tumors, including acoustic neuromas, were excluded from the study.