Do Medically Uncomplicated Patients Benefit from Early Discharge after Resection of Meningioma?

Introduction: Significant variability exists in postoperative length of stay practices. Surgical outcomes of skull base tumor surgery are predicted by multiple actors, most important the surgeon. However, nuanced decisions by immediate postoperative period may also impact outcomes. We hypothesized that in medically uncomplicated meningioma, early discharge—as a proxy for early mobilization—would be associated with better outcomes than an intermediate length of stay.

Methods: We conducted multivariable regression analyses on patients encoded to have resection of benign meningioma in the National Surgical Quality Improvement Program (NSQIP) databases from 2013 to 2015. Patients over 65 years old, with chronic medical comorbidities, or experiencing postoperative complications, were excluded. Early postoperative discharge (1–2 days) was compared with intermediate postoperative discharge (3–5 days). Extended discharge (6+ days) was also assessed.

Results: A total of 1,345 patients were included from NSQIP; of these, 40% had an early discharge of 1 to 2 days after surgery, while 41% had intermediate discharge and 20% had extended discharge. Patients with early and intermediate discharge had similar demographic features, though patients with early discharge had lower average operative times by 41 minutes (p < 0.001).

Thirty-day readmission occurred in 4.7 and 8.5% patients with early and intermediate discharge within the NSQIP databases on univariate analysis (odds ratio [OR]: 0.53, p = 0.01). This finding persisted after controlling for age, sex, operative time, and tumor location (OR, p = 0.57, p = 0.03). Indications for readmission were similar for both the early and intermediate discharge groups.

Postdischarge reoperation occurred in 0.7 and 2.9% patients with early and intermediate discharge, respectively, within the NSQIP databases (OR: 0.25, p = 0.01). After adjustment, this finding remained statistically significant (OR: 0.27, p = 0.03). Compared with intermediate discharge, extended discharge was not associated with increased rates of postdischarge reoperation or readmission before and after adjustment (p > 0.05).

Discussion: We find that medically uncomplicated meningioma patients who are discharged early after an operation have lower readmission, reoperation, and total charges. This population should be encouraged to meet postoperative goals to facilitate an early discharge. Further study is required to outline the optimal length of stay for other pathologies and sicker patients.

No conflict of interest has been declared by the author(s).