International Journal of Neurosurgery

Research Article | | Peer-Reviewed |

The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom

Received: 30 August 2023    Accepted: 14 September 2023    Published: 31 October 2023
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Abstract

Purpose: Day-case surgery for selected procedures has the potential to reduce healthcare costs and improve patient experience. In neurosurgery, brain biopsies have been performed as day-case procedures for selected patients. The purpose of this study is to demonstrate the safety and feasibility of a clinical pathway that facilitates day-case brain biopsy surgery to improve the generalisability of the evidence and inform wider adoption of this practice. Materials and methods: A single centre, retrospective study of patients aged ≥18 years requiring a brain biopsy for presumed tumour between November 2009 and December 2017 was performed. All patients received pre-admission radiology imaging +/- trajectory planning (as required), an operation on a morning theatre list and post-biopsy CT head 4-6 hours to rule out haemorrhage or other complications. Discharge was aimed at 6 hours post-biopsy if observations and CT were satisfactory. All data was collected via an institution operative database and descriptive statistical analysis was conducted. Results: A total of 447 brain tumour biopsies performed over the eight-year study period of which a total of n=160 (35.8%) were planned day-case. The proportion of biopsies performed as day-case increased over the study period, from four in 2009 to 33 per annum in 2017, an increase from only 10% (n=4) to 66% (n=33) of the total annual biopsies for this centre. Of the 160 planned day-cases, 135 (84.4%) were actual day-cases and successfully discharged on the same day as the operation. The mean patient age was 58 years. Twenty-five cases had at least one overnight unplanned stay, revealing a failure rate of 15.6%. Conclusions: This study demonstrates the safety of our day-case brain tumour biopsy service and is consistent with other centres’ experiences. This represents an opportunity for neurosurgeons to confidently contribute to an increasing provision of day-case surgery across the service.

DOI 10.11648/j.ijn.20230702.16
Published in International Journal of Neurosurgery (Volume 7, Issue 2, December 2023)
Page(s) 46-51
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Tumour, Biopsy, Patient Safety, Day-Case Surgery

References
[1] Abou-Zeid, A., Palmer, J. and Gnanalingham, K. (2014) ‘Day case lumbar discectomy–Viable option in the UK?’, British journal of neurosurgery, 28 (3), pp. 320–3.
[2] Alderwick, H. and Dixon, J. (2019) ‘The NHS long term plan’, BMJ (Online), 364. doi: 10.1136/bmj.l84.
[3] Audit Commission (1990) A short cut to better services: day surgery in England and Wales. London: HMSO.
[4] Audit Commission (2001) Day surgery: review of national findings. London: Audit Commission Publications.
[5] Aylin, P. et al. (2005) ‘Trends in day surgery rates.’, BMJ, 8 (331), p. 803.
[6] Bailey, C. et al. (2019) ‘Guidelines for day‐case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery.’, Anaesthesia, 74 (6), pp. 778–92.
[7] Bhardwaj, R. and Bernstein, M. (2002) ‘Prospective feasibility study of outpatient stereotactic brain lesion biopsy.’, Neurosurgery, (51), p. 358=364.
[8] Boulton, M. and Bernstein, M. (2008) ‘Outpatient brain tumor surgery: innovation in surgical neurooncology.’, Journal of neurosurgery, 108 (4), pp. 649–54.
[9] Cancer Research UK (2023) Brain, other CNS and intracranial tumours statistics.
[10] Darwin, L. and Chung, F. (2013) ‘Patient selection for day surgery.’, Anaesthesia & Intensive Care Medicine, 14 (3), pp. 114–118.
[11] Department of Health (2000) The NHS Plan: a plan for investment. a plan for reform.
[12] Field, M. et al. (2001) ‘Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy.’, J Neurosurgery, (94), pp. 545–551.
[13] Grundy, P., Weidmann, C. and Bernstein, M. (2008) ‘Day-case neurosurgery for brain tumours: the early United Kingdom experience.’, British journal of neurosurgery., 22 (3), pp. 360–7.
[14] Heper, A. et al. (2005) ‘An analysis of stereotactic biopsy of brain tumors and nonneoplastic lesions: a prospective clinicopathologic study.’, Surgical neurology, 1 (64), pp. 82–8.
[15] Kaakaji, W., Barnett, G. and Bernhard, D. (2001) ‘Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy.’, J Neurosurg, (94), pp. 892–8.
[16] Kulkarni, A. et al. (1998) ‘Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy.’, J Neurosurg, (89), pp. 31–35.
[17] Lemos, P. et al. (2009) ‘Patient satisfaction following day surgery.’, Journal of Clinical Anaesthesia, (21), pp. 200–205.
[18] Mirian, C. et al. (2019) ‘Antiepileptic drugs as prophylaxis for de novo brain tumour-related epilepsy after craniotomy: a systematic review and meta-analysis of harm and benefits.’, J Neurol Neurosurg Psychiatry, 90 (5), pp. 599–607.
[19] NICE (2021) Brain tumours (primary) and brain metastases in over 16s.
[20] Purzner, T. et al. (2011) ‘Outpatient brain tumor surgery and spinal decompression: a prospective study of 1003 patients.’, Neurosurgery, 69 (1), pp. 119–27.
[21] Quemby, D. and Stocker, M. (2014) ‘Day surgery development and practice: key factors for a successful pathway.’, Continuing Education in Anaesthesia, Critical Care & Pain., 14 (6), pp. 256–61.
[22] Reisch, R. et al. (2013) ‘The keyhole concept in neurosurgery.’, World neurosurgery, 79 (2), pp. 17–19.
[23] Richardson, A. et al. (2019) ‘Predictors of Successful Discharge of Patients on Postoperative Day 1 After Craniotomy for Brain Tumor.’, World neurosurgery, 1 (126), pp. 869–77.
[24] Sawin, P. et al. (1998) ‘Computed imaging-assisted stereotactic brain biopsy: A risk analysis of 225 consecutive cases.’, Surg Neurol, (49), pp. 640–640.
[25] Taylor, W. et al. (1995) ‘Timing of post- operative intracranial hematoma development and implications for the best use of neurosurgical intensive care.’, J Neurosurg, (82), pp. 48–50.
[26] Vaishnav, A. and McAnany, S. (2019) ‘Future endeavors in ambulatory spine surgery.’, Journal of Spine Surgery, 2.
[27] Vallejo, F. et al. (2022) ‘Same-day discharge after brain tumor resection: a prospective pilot study.’, Journal of Neuro-oncology, 157 (2), pp. 345–53.
[28] Venkatraghavan, L. et al. (2016) ‘Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study.’, Canadian Journal of Anesthesia, 63 (11), pp. 1245–57.
[29] Weerakkody, R. et al. (2009) ‘The air bubble technique for confirming the location of an image-guided biopsy - a technical note.’, Br J Neurosurg, 29 (3), pp. 329–31.
[30] Wohns, R. (2010) ‘Safety and cost-effectiveness of outpatient cervical disc arthroplasty.’, Surgical neurology international.
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  • APA Style

    William Bolton, Fozia Saeed, Sandeep Solanki, Gnanamurthy Sivakumar, Robert Corns, et al. (2023). The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom. International Journal of Neurosurgery, 7(2), 46-51. https://doi.org/10.11648/j.ijn.20230702.16

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    ACS Style

    William Bolton; Fozia Saeed; Sandeep Solanki; Gnanamurthy Sivakumar; Robert Corns, et al. The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom. Int. J. Neurosurg. 2023, 7(2), 46-51. doi: 10.11648/j.ijn.20230702.16

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    AMA Style

    William Bolton, Fozia Saeed, Sandeep Solanki, Gnanamurthy Sivakumar, Robert Corns, et al. The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom. Int J Neurosurg. 2023;7(2):46-51. doi: 10.11648/j.ijn.20230702.16

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  • @article{10.11648/j.ijn.20230702.16,
      author = {William Bolton and Fozia Saeed and Sandeep Solanki and Gnanamurthy Sivakumar and Robert Corns and John Goodden and Paul Chumas and Simon Thomson},
      title = {The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom},
      journal = {International Journal of Neurosurgery},
      volume = {7},
      number = {2},
      pages = {46-51},
      doi = {10.11648/j.ijn.20230702.16},
      url = {https://doi.org/10.11648/j.ijn.20230702.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20230702.16},
      abstract = {Purpose: Day-case surgery for selected procedures has the potential to reduce healthcare costs and improve patient experience. In neurosurgery, brain biopsies have been performed as day-case procedures for selected patients. The purpose of this study is to demonstrate the safety and feasibility of a clinical pathway that facilitates day-case brain biopsy surgery to improve the generalisability of the evidence and inform wider adoption of this practice. Materials and methods: A single centre, retrospective study of patients aged ≥18 years requiring a brain biopsy for presumed tumour between November 2009 and December 2017 was performed. All patients received pre-admission radiology imaging +/- trajectory planning (as required), an operation on a morning theatre list and post-biopsy CT head 4-6 hours to rule out haemorrhage or other complications. Discharge was aimed at 6 hours post-biopsy if observations and CT were satisfactory. All data was collected via an institution operative database and descriptive statistical analysis was conducted. Results: A total of 447 brain tumour biopsies performed over the eight-year study period of which a total of n=160 (35.8%) were planned day-case. The proportion of biopsies performed as day-case increased over the study period, from four in 2009 to 33 per annum in 2017, an increase from only 10% (n=4) to 66% (n=33) of the total annual biopsies for this centre. Of the 160 planned day-cases, 135 (84.4%) were actual day-cases and successfully discharged on the same day as the operation. The mean patient age was 58 years. Twenty-five cases had at least one overnight unplanned stay, revealing a failure rate of 15.6%. Conclusions: This study demonstrates the safety of our day-case brain tumour biopsy service and is consistent with other centres’ experiences. This represents an opportunity for neurosurgeons to confidently contribute to an increasing provision of day-case surgery across the service.
    },
     year = {2023}
    }
    

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    T1  - The Feasibility and Safety of Day Case Brain Tumour Biopsy: An Eight-Year Experience in the United Kingdom
    AU  - William Bolton
    AU  - Fozia Saeed
    AU  - Sandeep Solanki
    AU  - Gnanamurthy Sivakumar
    AU  - Robert Corns
    AU  - John Goodden
    AU  - Paul Chumas
    AU  - Simon Thomson
    Y1  - 2023/10/31
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ijn.20230702.16
    DO  - 10.11648/j.ijn.20230702.16
    T2  - International Journal of Neurosurgery
    JF  - International Journal of Neurosurgery
    JO  - International Journal of Neurosurgery
    SP  - 46
    EP  - 51
    PB  - Science Publishing Group
    SN  - 2640-1959
    UR  - https://doi.org/10.11648/j.ijn.20230702.16
    AB  - Purpose: Day-case surgery for selected procedures has the potential to reduce healthcare costs and improve patient experience. In neurosurgery, brain biopsies have been performed as day-case procedures for selected patients. The purpose of this study is to demonstrate the safety and feasibility of a clinical pathway that facilitates day-case brain biopsy surgery to improve the generalisability of the evidence and inform wider adoption of this practice. Materials and methods: A single centre, retrospective study of patients aged ≥18 years requiring a brain biopsy for presumed tumour between November 2009 and December 2017 was performed. All patients received pre-admission radiology imaging +/- trajectory planning (as required), an operation on a morning theatre list and post-biopsy CT head 4-6 hours to rule out haemorrhage or other complications. Discharge was aimed at 6 hours post-biopsy if observations and CT were satisfactory. All data was collected via an institution operative database and descriptive statistical analysis was conducted. Results: A total of 447 brain tumour biopsies performed over the eight-year study period of which a total of n=160 (35.8%) were planned day-case. The proportion of biopsies performed as day-case increased over the study period, from four in 2009 to 33 per annum in 2017, an increase from only 10% (n=4) to 66% (n=33) of the total annual biopsies for this centre. Of the 160 planned day-cases, 135 (84.4%) were actual day-cases and successfully discharged on the same day as the operation. The mean patient age was 58 years. Twenty-five cases had at least one overnight unplanned stay, revealing a failure rate of 15.6%. Conclusions: This study demonstrates the safety of our day-case brain tumour biopsy service and is consistent with other centres’ experiences. This represents an opportunity for neurosurgeons to confidently contribute to an increasing provision of day-case surgery across the service.
    
    VL  - 7
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Author Information
  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom; Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

  • Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, United Kingdom

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