The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom

Purpose: Day-case surgery for selected procedures has the potential to reduce healthcare costs and improve patient experience. In neurosurgery, brain biopsies have been performed as day-case procedures for selected patients. The purpose of this study is to demonstrate the safety and feasibility of a clinical pathway that facilitates day-case brain biopsy surgery to improve the generalisability of the evidence and inform wider adoption of this practice. Materials and methods: A single centre, retrospective study of patients aged ≥18 years requiring a brain biopsy for presumed tumour between November 2009 and December 2017 was performed. All patients received pre-admission radiology imaging +/- trajectory planning (as required), an operation on a morning theatre list and post-biopsy CT head 4-6 hours to rule out haemorrhage or other complications. Discharge was aimed at 6 hours post-biopsy if observations and CT were satisfactory. All data was collected via an institution operative database and descriptive statistical analysis was conducted. Results: A total of 447 brain tumour biopsies performed over the eight-year study period of which a total of n=160 (35.8%) were planned day-case. The proportion of biopsies performed as day-case increased over the study period, from four in 2009 to 33 per annum in 2017, an increase from only 10% (n=4) to 66% (n=33) of the total annual biopsies for this centre. Of the 160 planned day-cases, 135 (84.4%) were actual day-cases and successfully discharged on the same day as the operation. The mean patient age was 58 years. Twenty-five cases had at least one overnight unplanned stay, revealing a failure rate of 15.6%. Conclusions: This study demonstrates the safety of our day-case brain tumour biopsy service and is consistent with other centres’ experiences. This represents an opportunity for neurosurgeons to confidently contribute to an increasing provision of day-case surgery across the service.