Outpatient treatment of cerebral aneurysms: A case series

Goland, Javier; Doroszuk, Gustavo; Ypa, Paula; Leyes, Paula; Garbugino, Silvia

doi:10.25259/sni_569_2020

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Although this study is based on a recent single-referral center experience in Korea, we nevertheless demonstrated that aneurysm embolization could be achieved via outpatient day-care management, and showed the possibility that cases could be managed in an outpatient clinic. To our knowledge, to date, few studies have investigated the issue of possible outpatient management for UIA [ 18 ]. The criteria to decide the length of the admission period may depend on post-procedural day one DWI and MRA, as well as patient status.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

et al. 2022

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Objective This study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods. Materials and Methods This retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage. Results The mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6–53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6–53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes. Conclusion This study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

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Section: Discussionmentioning

confidence: 99%

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

et al. 2022

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“…Same-day discharge after neuroangiography has been well-described as both safe and cost-minimizing. [18][19][20][21] As similar advances are made in the microsurgical aneurysm repair cohorts, 11,22,23 the neuroendovascular realm should seek to improve our discharge protocols as well. 24 Early discharge did not increase the rate of readmission nor the overall complication rate.…”

Section: Discussionmentioning

confidence: 99%

Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques

et al. 2022

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Introduction As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources. Methods Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined. Results 330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019–2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission. Discussion Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system. Conclusion We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols.

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“…Same-day discharge after craniotomy has been performed since 1996 [5,6,12], most commonly for biopsy or tumor resection. In addition, transsphenoidal resection of pituitary tumor [13 ▪ ,14 ▪ ], clipping [15] and coiling [16 ▪ ] of cerebral aneurysms have also been successfully performed as same-day discharge procedures. A more detailed description of the studies on same-day discharge after neurosurgery is presented in Table 1.…”

Section: Feasibility and Safetymentioning

confidence: 99%

Same day discharge for craniotomy

Goldmacher¹,

Bernstein

Venkatraghavan³

2021

Current Opinion in Anaesthesiology

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Purpose of reviewSame-day protocols for craniotomy have been demonstrated to be feasible and safe. Its several benefits include decreased hospital costs, less nosocomial complications, fewer case cancellations, with a high degree of patient satisfaction. This paper reviews the most recent publications in the field of same-day discharge after craniotomy. Recent findingsSince 2019, several studies on same-day neurosurgical procedures were published. Ambulatory craniotomy protocols for brain tumor were successfully implemented in more centers around the world, and for the first time, in a developing country. Additional information emerged on predictors for successful early discharge, and the barriers and enablers of same-day craniotomy programs. Moreover, the cost benefits of same-day craniotomy were reaffirmed. SummarySame-day discharge after craniotomy is feasible, safe and continues to expand to a wider variety of procedures, in new institutions and countries. There are several benefits to ambulatory surgery. Wellestablished protocols for perioperative management are essential to the success of early discharge programs. With continued research, these protocols can be refined and implemented in more institutions globally, ultimately to provide better, more efficient care for neurosurgical patients.

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Outpatient treatment of cerebral aneurysms: A case series

Cited by 5 publications

References 24 publications

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques

Same day discharge for craniotomy

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