Safety and Costs Analysis of a Fast-track Algorithm for Early Hospital Discharge After Brain Tumor Surgery

Abstract

Abstract INTRODUCTION Until the 1990 s, perioperative care was based on empirical concepts and common practice, in part due to the paucity of scientific evidence. With the need of improving patient outcomes and reducing costs, the concern of developing safe and effective standards in postoperative care emerged. Recently, our institution has adopted a daily algorithm for hospital discharge (DAHD), which is a key point in the concept of Fast-Track Surgery. Thus, we designed a study to evaluate whether there was a difference in length of stay (LOS), rate of complications, and hospital costs after the introduction of the DAHD in the postoperative management of patients who underwent brain tumor resection. METHODS This is a retrospective cohort study. All consecutive patients who underwent brain tumor resection in 2017 by a single neurosurgeon were analyzed. Demographic and procedure-related variables, clinical outcomes, and healthcare costs within 30 d after surgery were collected and compared in patients before (preimplementation) and after (postimplementation) the daily algorithm for hospital discharge (DAHD). RESULTS About 61 patients who had been submitted to brain tumor resection were studied (preimplementation 32, postimplementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS after surgery in days decreased significantly (median 5 vs 3 days; P = .001). The proportion of patients who were discharged within day 1 or 2 after surgery was significantly higher after DAHD protocol (3.1% vs 44.8%; P < .001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, P = .043), mainly due to a reduction in median ward costs (US$922 vs US$1623, P = .009). CONCLUSION Early discharge after brain tumor surgery was safe, inexpensive, reduced the LOS, and hospitalization costs without increase in readmission rate or postoperative complications.