Sleepers Awake

Conscious sedation for brain surgery may shorten hospital stay

E Antonio ChioccaThe recovery time and cost of brain-tumor surgery might be reduced if surgery is performed while patients are awake during part of the procedure, a study at the OSUCCC – James suggests. The study examined the outcomes of 39 patients treated for glioma. Doctors wanted to learn whether patients who received conscious sedation had outcomes different from those who underwent general anesthesia.

“Our data suggest that patients who received conscious sedation had shorter hospital stays, and that this reduced the cost of treatment,” says study leader E. Antonio Chiocca, MD, PhD, professor and chair of Neurological Surgery. “This finding must be validated with a randomized prospective clinical trial, but if it holds true, it would mean that changing our way of delivering anesthesia may allow these patients to leave sooner and save resources.”

Neurosurgeons usually reserve conscious sedation for patients with tumors near the brain’s speech and sensorimotor centers, Chiocca says. The method was conceived in the 1950s to avoid or minimize damage to these centers. Since then, several studies have indicated that conscious sedation can result in more complications than general anesthesia, while other studies appear to show the opposite.

To investigate this question, Chiocca and colleagues studied the outcomes of 20 cases that used conscious sedation during surgery for gliomas and compared them with 19 cases that used general anesthesia.

The researchers evaluated patients for the number of days they remained in the hospital and for the cost of four items related to the surgery: the operating room, anesthesia, neurosurgical intensive care and the hospital room. Each patient was also evaluated for neurological complications.

No significant differences were found in the percentage of complications. As for the costs, the expense associated with the operating room and anesthesia were the same in both groups, and both groups spent similar time in intensive care. However, patients receiving conscious sedation had shorter hospital stays after leaving intensive care than patients receiving general anesthesia—3.5 vs. 4.6 days.

And the shorter hospital stays led to an average 36-percent decrease in post-intensive-care direct cost for cases receiving conscious sedation.

Published in the journal Cancer Prevention Research.

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