INTRODUCTION: Length of stay (LOS) following surgery is highly variable between providers. Techniques can be employed to minimise LOS to the benefit of patients, providers and the NHS. Data is now available to benchmark and to provide an opportunity for aspiring to best practice.
METHODS: We introduced measures to reduce LOS. We explored data from Hospital Episode Statistics published for providers by the National Neurosurgical Audit Program (NNAP) and Get It Right First Time (GIRFT) in 2016/7.
RESULTS: In our unit the most frequent pathway for surgery for brain tumours was as elective admissions: 75% of patients with high-grade gliomas; 81% with metastases and 85% with benign tumours were admitted for surgery in an elective manner. Median LOS for intrinsic tumours was 1 day (versus national 6 days, NNAP). Mean LOS (vs national) was 2.5 (6.4) days for HGG; 2.9 (6.5) days for metastases; 4.7 (9.2) days for benign tumours; all the lowest in UK. Despite this, readmission rates were within the normal range at 20% (18%) for HGG; 21% (20%) for metastases;15% (14%) for benign tumours. Re-operation rates over 1 year were also in normal range: 11% (12%) HGG; 9% (11%) for metastases; 12% (11%) for benign tumours. Elective cranial mortality was 0.87 (0.94).
DISCUSSION: Adopting several strategies to minimise LOS has proven very successful and resulted in excellent benchmarked data. This has proven popular with patients, has improved efficiency at our trust, reduced cost, cancellations and waiting times and has more widespread implications across the NHS. Short stay neurosurgery for brain tumours is safe and does not significantly increase readmission, re-operation or mortality rates.Techniques employed to deliver this will be discussed.
CONCLUSION: All providers of neurosurgery should use national data to improve practice in the future, including engaging with peers and utilising strategies proven to be successful elsewhere.
