Safety and costs analysis of early hospital discharge after brain tumour surgery: a pilot study

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorNEVILLE, Iuri Santana
dc.contributor.authorURENA, Francisco Matos
dc.contributor.authorQUADROS, Danilo Gomes
dc.contributor.authorSOLLA, Davi J. F.
dc.contributor.authorLIMA, Mariana Fontes
dc.contributor.authorSIMOES, Claudia Marquez
dc.contributor.authorVICENTIN, Eduardo
dc.contributor.authorRIBEIRO JR., Ulysses
dc.contributor.authorAMORIM, Robson Luis Oliveira
dc.contributor.authorPAIVA, Wellingson Silva
dc.contributor.authorTEIXEIRA, Manoel Jacobsen
dc.date.accessioned2020-08-20T13:21:40Z
dc.date.available2020-08-20T13:21:40Z
dc.date.issued2020
dc.description.abstractBackground A daily algorithm for hospital discharge (DAHD) is a key point in the concept of Enhanced Recovery After Surgery (ERAS) protocol. We aimed to evaluate the length of stay (LOS), rate of complications, and hospital costs variances after the introduction of the DAHD compared to the traditional postoperative management of brain tumour patients. Methods This is a cohort study with partial retrospective data collection. All consecutive patients who underwent brain tumour resection in 2017 were analysed. Demographics and procedure-related variables, as well as clinical outcomes, LOS and healthcare costs within 30 days after surgery were compared in patients before/pre-implementation and after/post-implementation the DAHD, which included: stable neurological examination; oral feeding without aspiration risk; pain control with oral medications; no intravenous medications. The algorithm was applied every morning and discharge was considered from day 1 after surgery if criteria was fulfilled. The primary outcome (LOS after surgery) analysis was adjusted for the preoperative performance status on a multivariable logistic regression model. Results A total of 61 patients were studied (pre-implementation 32, post-implementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS decreased significantly (median 5 versus 3 days; p = 0.001) and the proportion of patients who were discharged on day 1 or 2 after surgery increased (44.8% vs 3.1%; p < 0.001). 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 = 0.043), mainly due to a reduction in median ward costs (US$922 vs US$1623, p = 0.009). Conclusions Early discharge after brain tumour surgery appears to be safe and inexpensive. The LOS and hospitalization costs were reduced without increasing readmission rate or postoperative complications.eng
dc.description.conferencedateOCT 19-23, 2019
dc.description.conferencelocalSan Francisco, CA
dc.description.conferencenameAnnual Meeting of the Congress-of-Neurological-Surgeons
dc.description.indexMEDLINEeng
dc.identifier.citationBMC SURGERY, v.20, n.1, article ID 105, 10p, 2020
dc.identifier.doi10.1186/s12893-020-00767-y
dc.identifier.eissn1471-2482
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/36839
dc.language.isoeng
dc.publisherBMCeng
dc.relation.ispartofBMC Surgery
dc.rightsopenAccesseng
dc.rights.holderCopyright BMCeng
dc.subjectBrain tumourseng
dc.subjectDischargeeng
dc.subjectERASeng
dc.subjectEnhanced recovery after surgeryeng
dc.subjectPostoperative length of stayeng
dc.subject.otherfast-track recoveryeng
dc.subject.other30-day readmissioneng
dc.subject.otherenhanced recoveryeng
dc.subject.othercraniotomyeng
dc.subject.othercareeng
dc.subject.otherrateseng
dc.subject.wosSurgeryeng
dc.titleSafety and costs analysis of early hospital discharge after brain tumour surgery: a pilot studyeng
dc.typearticleeng
dc.type.categoryarticle; proceedings papereng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.author.externalLIMA, Mariana Fontes:Univ Fed Sao Paulo, Hosp Sao Paulo, Div Anaesthesiol, Sao Paulo, Brazil
hcfmusp.citation.scopus15
hcfmusp.contributor.author-fmusphcIURI SANTANA NEVILLE RIBEIRO
hcfmusp.contributor.author-fmusphcFRANCISCO DEL ROSARIO MATOS URENA
hcfmusp.contributor.author-fmusphcDANILO GOMES QUADROS
hcfmusp.contributor.author-fmusphcDAVI JORGE FONTOURA SOLLA
hcfmusp.contributor.author-fmusphcCLAUDIA MARQUEZ SIMOES
hcfmusp.contributor.author-fmusphcEDUARDO APARECIDO VICENTIN
hcfmusp.contributor.author-fmusphcULYSSES RIBEIRO JUNIOR
hcfmusp.contributor.author-fmusphcROBSON LUIS OLIVEIRA DE AMORIM
hcfmusp.contributor.author-fmusphcWELLINGSON SILVA PAIVA
hcfmusp.contributor.author-fmusphcMANOEL JACOBSEN TEIXEIRA
hcfmusp.description.articlenumber105
hcfmusp.description.issue1
hcfmusp.description.volume20
hcfmusp.origemWOS
hcfmusp.origem.pubmed32410602
hcfmusp.origem.scopus2-s2.0-85084855796
hcfmusp.origem.wosWOS:000536177100002
hcfmusp.publisher.cityLONDONeng
hcfmusp.publisher.countryENGLANDeng
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