The Impact of Metastatic Brain Lesions on Enhanced Recovery After Surgery Protocols for Elective and Emergent Supratentorial Brain Tumor Surgery: A Retrospective Review

BACKGROUND AND OBJECTIVES: Enhanced Recovery After Surgery protocols are increasingly being used in neurosurgery, with multiple postoperative day (POD) zero and POD1 discharge protocols being implemented for patients undergoing craniotomies for brain tumor resection. We discuss our experience with implementing a POD1 protocol for patients both admitted electively and from the emergency department (ED). METHODS: We conducted a retrospective cohort study of 61 consecutive patients treated with craniotomies for brain tumor resection at Jersey Shore University Medical Center by a single surgeon from August 2022 to April 2024. RESULTS: A total of 39 patients met the inclusion criteria for POD1 discharge protocol. Of these 33.3% (n = 13) were successfully discharged on POD1, whereas 38.5% (n = 15) were cleared by neurosurgery on POD1 but required additional management before discharge. There were 7 ED visits and readmissions within 30 days, of which 3 were neurosurgery related. One patient had a planned reoperation, another patient had rapid tumor recurrence, and the third patient had symptomatic hyponatremia. There were no statistically significant differences in hospital stay between patients admitted electively vs through the ED. The only statistically significant factor was metastatic disease. Specifically, patients with metastatic disease had significantly longer hospital stays (t = 2.14 days, P = .04) and longer discharge delays (t = 2.25 days, P = .04) compared with those with nonmetastatic disease. CONCLUSION: We found no statistically significant difference between elective and ED admitted patients regarding hospital length of stay or discharge delay, suggesting that both cohorts can successfully participate in this protocol. The only significant delaying factor was metastatic disease, with many patients presenting with brain tumors as the first sign of underlying malignancy. We suggest that for patients with metastatic disease to the brain, only patients with established cancer diagnoses be included in these Enhanced Recovery After Surgery protocols.