Evaluating predictors of successful postoperative day 1 discharge following posterior fossa tumor resection

Abstract INTRODUCTION: Current trends in surgical neuro-oncology have shown that early discharges are both safe and feasible with shorter lengths of stay (LOS) associated with fewer thromboembolic complications, less hospital-acquired infections, reduced costs, and greater patient satisfaction. Traditionally, infratentorial tumor resections have been associated with longer LOS and limited data exists evaluating predictors of early discharge in these patients. The objective was to assess patients undergoing posterior fossa craniotomies for tumor resection and identify variables associated with a postoperative day 1 (POD1) discharge and determine any differences in outcomes and readmission rates. METHODS: A retrospective review of posterior fossa craniotomies for tumor resection at our institution was performed from 2011 to 2020. Laser ablations, craniotomies for non-tumoral pathologies, and biopsies were excluded. Complete demographic, clinical, surgical and postoperative data was collected for each patient. RESULTS: 173 patients were identified and 25 (14.5%) were discharged on POD1. Median length of stay was 6 days. The POD1 discharges had significantly better preoperative Karnofsky performance scores (p<0.001) and modified Rankin scores (p=0.002) and less frequently presented emergently (p=0.006) or with preoperative neurologic deficits (p=0.021). No statistically significant difference in 30-day readmissions and rates of PE, UTI, and DVT were found between the POD1 discharge cohort and those discharged later. Univariate logistic regression identified better preoperative functional status, elective admission, and lack of preoperative hydrocephalus as independent predictors of POD1 discharge however only the latter remained significant in the multivariable model (p=0.001). CONCLUSIONS: Discharging patients on POD1 is feasible following posterior fossa tumor resections and does not introduce any significant undue risk or result in higher readmissions. Although we found that the only independent predictor for a longer LOS was preoperative hydrocephalus, larger, prospective studies are needed to confirm these findings.