Same-day discharge after pediatric neurosurgical procedures: a single-institution experience.

BACKGROUND AND

OBJECTIVES

Same-day discharge (SDD) after neurosurgical procedures in children remains underexplored. To our knowledge, this represents one of the first modern North American single-institution series to include SDD after major pediatric spinal instrumentation and procedures performed on children of elevated anesthetic risk.

METHODS

A retrospective review of all neurosurgical procedures performed at an academic, tertiary referral center was conducted. Patients were identified as those who underwent surgery and were discharged on the same calendar day (length of stay [LOS] = 0 days). Patient demographics, procedural details, operative times, ASA classification, intraoperative complications, postoperative outcomes, and symptom status at follow-up were recorded.

RESULTS

Of 976 neurosurgical encounters, 87 (8.9%) had a 0-day LOS, of which 75 were in patients younger than 18 years. Sixteen encounters in 16 unique pediatric patients met all inclusion criteria and were analyzed. Median age at surgery was 14.7 years (interquartile range [IQR] 7.1-16.1; range 0.1-17.4), with equal distribution by sex (8 males, 8 females). Procedures were classified as major in 14 encounters (87.5%) and minor in 2 (12.5%). Median operative time was 103 min (IQR 65-111; range 43-188). There were no intraoperative complications (0%), no surgical site infections (0%), no 7-day reoperations (0%), and no operative failures at first follow-up imaging (0%). No patient was readmitted within 30 days (0%), and 2 (12.5%) returned to the emergency department within 30 days, both managed without admission. At follow-up, symptoms were stable or improved in 14 of 16 encounters (87.5%). Fifteen patients were discharged on the operative calendar day; 1 was observed overnight and discharged the following morning.

CONCLUSIONS

In this small, heterogeneous retrospective series, a diverse range of pediatric neurosurgical procedures, including major spinal and intracranial operations, were managed with SDD without serious complications. These preliminary observations are hypothesis-generating; careful patient selection remains paramount, and larger prospective studies are needed before broader adoption.