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Same-Day Discharge Pathway in DBS Electrode Placement
Surgery
Farrokh Farrokhi, MD Virginia Mason Franciscan Health
Aaradhya Pant, BS, Stanford School of Medicine; Christine Palermo, MD,
Virginia Mason Franciscan Health; Samira Pardakhtim, ARNP, Univ. of
Washington School of Medicine; John Roberts, MD, Virginia Mason
Franciscan Health; Sindhu Srivatsal, MD, Virginia Mason Franciscan Health
Maria Marsans, PAC, Virginia Mason Franciscan Health
Introduction: Deep Brain Stimulation (DBS) surgery has evolved
into a highly effective procedure for treating an expanding number of
neurological conditions. While DBS surgery has demonstrated low
rates of serious complications, it is typically followed by an inpatient
hospital stay. A primary barrier to discharging patients same-day is
uncontrolled postoperative hypertension, which may lead to serious
complications such as intracranial hemorrhage.
In recent years, a combination of limited hospital resources, the growing
demand for DBS, and other restrictions on elective, hospital-based
procedures have contributed to a shift in the care model. Access to elective
surgeries are further limited due to the ongoing nursing shortage and
preferences of nurses for working in outpatient settings. To preserve
inpatient resources and increase patient accessibility, a transition to
outpatient DBS surgery or same-day discharge following DBS surgery is
emerging. This discharge model has been previously reported as safe.
However, to our best knowledge, no study has evaluated which patient
factors can be leveraged to guide the selection of patients suitable for same-
day discharge.
Methods: Commencing in January 2022, our institution began a rapid
discharge pathway for DBS patients on the same day following surgery. This
change in practice provided two cohorts: patients in the same-day pathway
and inpatient overnight pathway. Here, we first retrospectively analyzed
these two cohorts from January 2022 to July 2023 to determine (1) which, if
any, pre-operative factors can predict whether a patient will be discharged
same-day and (2) how these pre-operative factors could influence patient
selection for same-day discharge.
Results: We found no discernible pre-operative factors to predict the
likelihood of same-day discharge after DBS surgery. Recognizing the
limitations of pre-operative factors, combined with uncontrolled
hypertension being a known barrier to early discharge, we subsequently
focused on postoperative antihypertensive medication administration in all
patients prior to January 2022. Our analysis underscores the potential for a
significant proportion of patients to be considered for same-day discharge
based on better preoperative hypertension management, potentially leading
to significant healthcare cost savings.