• Lashmi Venkatraghavan, Suparna Bharadwaj, Karolyn Au, Mark Bernstein, and Pirjo Manninen.
• Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. lashmi.venkatraghavan@uhn.on.ca.
• Can J Anaesth. 2016 Nov 1; 63 (11): 1245-57.

PurposeEnhanced Recovery After Surgery is a multimodal perioperative care pathway designed to achieve early discharge in patients undergoing major surgery. Recent advances in neurosurgery allow for shorter duration of anesthesia and surgery, faster recovery, and earlier discharge from hospital. The purpose of this retrospective observational study was to assess the incidence of early discharge from hospital in patients undergoing craniotomy for supratentorial brain tumours as well as to explore the associated perioperative factors, anesthesia techniques, and complications.MethodsThe medical records of all patients who underwent craniotomy (less than four-hour duration) for supratentorial tumour over a five-year period were retrospectively reviewed. The data analyzed included the postoperative discharge destination, type of anesthesia-i.e., general anesthesia (GA) vs awake craniotomy (AC), and the incidence of adverse events.ResultsData from 329 patients [mean (SD) age 48 (12) yr; 164 male, 165 female] were analyzed, including 198 (AC, n = 157; GA, n = 41) patients who were preoperatively scheduled for same-day discharge. Successful same-day discharge occurred in 175/198 (88.4%) of these patients (AC, n = 139; GA, n = 36). Five (2.9%) of the 175 patients (4 AC, 1 GA) with same-day discharge required readmission to hospital within the first 12 hr after discharge. Six (1.8%) of the 329 total patients had a documented postoperative intracranial bleed, but none occurred after initial discharge from hospital.ConclusionSame-day discharge from hospital is possible in carefully selected patients after both GA and AC for supratentorial tumour surgery.

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