Reduced Time to Imaging, Length of Stay, and Hospital Charges Following Implementation of a Novel Post-operative Pathway for Craniotomies for Brain Tumors

Introduction: We created a post-operative post-anesthesia care unit (PACU) pathway for patients undergoing routine craniotomies to bypass routine intensive care unit (ICU) admissions. In this study, we evaluate the impact of our novel clinical pathway on patient outcomes and hospital charges.

Methods: This is a single-institution retrospective cohort study of comparing 202 patients undergoing craniotomy for brain tumor enrolled in a PACU-to-floor pathway from 2020-2022 and 193 similar historic controls. Our criteria for inclusion include a craniotomy with case time < 6 hours, blood loss under 500ml, and no intra-operative seizures or complications.

Results: Pathway enrollees had a median age of 61 years (interquartile range 49-69) and 53% were female. Age, sex, pathology, and ASA class distributions were similar between PACU pathway and control patients (p>0.05 for all). Seven pathway cases (3.5%) were escalated to the ICU post-operatively because of new post-operative neurological deficits (4 cases), attending preference (2 cases), and agitation (1 case).

Average time-to-MRI was 6.6 hours faster for pathway patients (p < 0.001) and time-to-inpatient physical therapy evaluation was 4.1 hours faster (p=0.046). Average total length-of-stay was 0.7 days shorter for pathway patients (p=0.0016). Average total hospitalization charges were $13,448 lower for pathway patients, representing a 7.4% decrease (p=0.0012). These findings were consistent for all start times and for weekday and weekend operations alike. Patients were discharged home in 86% of pathway cases compared to 81% of controls (p=0.225). In total, 19% of pathway patients had thirty-day readmissions or emergency room evaluations compared to 18% of control patients (p=0.897).

Additionally, we identify and summarize 11 post-operative protocols for brain tumor patients designed to bypass routine ICU admission including this report.

Conclusion : Our PACU-to-floor pathway reduces length-of-stay, time-to-imaging, and hospital charges after craniotomy for brain tumors without worsening discharge disposition or hospital readmissions.