The retrospective analysis covered 263 consecutive patients operated on between November 2022 and December 2023. Of these, 146 patients — 55.5 percent — were discharged on post-operative day one, or POD1 in the shorthand of surgical teams. The number is striking because early discharge after craniotomy remains rare in routine neurosurgical practice globally, even though evidence has been accumulating for years that many post-operative complications reveal themselves within hours rather than days of surgery. Southampton has been quietly refining its early discharge strategy since 2006, and the pathway evaluated in this study is the product of nearly two decades of institutional experience.

The safety signal is the core of the story. Across the entire cohort, 8.0 percent of patients were readmitted to hospital unplanned within 30 days of discharge. Among those sent home on day one, the figure was almost identical at 7.5 percent. Statistically, the team found no significant association between early discharge and readmission, with an odds ratio of 0.87 and a confidence interval that comfortably spans unity. In other words, going home quickly did not make patients more likely to bounce back through the emergency department door. Mean time to readmission was 9.9 days in the early discharge group, suggesting problems, when they emerged, did so on a timeline largely independent of when patients left hospital.

The study also measured something more revealing than readmission alone: cumulative hospital days within 30 days of surgery. Patients discharged on POD1 accumulated a mean of just 1.0 hospital day, compared with 7.0 days among those requiring prolonged admission. This metric matters because it captures whether savings from early discharge are simply eaten up by later readmissions. In Southampton’s data, they were not. The one-day cohort occasionally did return — a small number needed stays averaging 5.4 days when they did — but the arithmetic still came out overwhelmingly in favour of getting patients home.

The pathway itself is a structured blend of pre-operative selection and same-day logistics. Candidates for early discharge needed good baseline functional status, no major medical frailty, an anticipated uncomplicated recovery, and the ability to mobilise safely. Final eligibility demanded four checkpoints: completion of a post-operative MRI, clearance from physiotherapy and occupational therapy, a stable neurological examination, and overall medical fitness. Patients left with a printed discharge summary, written instructions on warning signs after craniotomy, verbal briefing from ward nurses, and a direct phone line to the neuro-oncology clinical nurse specialist. Follow-up happened through a telephone clinic once histopathology results were available, and the team cross-checked regional referral systems and contacted peripheral hospitals by phone to catch readmissions anywhere in the network.

What stopped the other patients from going home early? The answer, overwhelmingly, was what happened in the immediate hours after surgery. Post-operative adverse events reduced the odds of POD1 discharge by 82 percent, and new or worsened neurological deficits — affecting movement, speech, sensation, vision or cognition — reduced them by 95 percent. Dysphasia was the most common deficit among those with prolonged admissions. Diabetes mellitus was the only pre-operative factor that significantly predicted a longer stay, cutting the odds of early discharge by more than half, though interestingly, peri-operative corticosteroid use in diabetic patients showed no link to discharge timing, and none of the readmitted patients came back with diabetes-related complications. The authors suggest the diabetes finding reflects clinical caution rather than genuine metabolic risk.

On the readmission side, one anatomical factor stood out: tumours in eloquent brain regions — areas controlling speech, movement or other critical functions — tripled the odds of an unplanned return to hospital, with an odds ratio of 3.35. The pattern extended to the reasons for those returns. Patients with eloquent-region tumours were most often readmitted with seizures, while those with tumours elsewhere mostly came back with weakness. The implication is sobering: even when surgery near functional brain areas goes smoothly and patients pass all discharge criteria, they carry a heightened risk of delayed neurological deterioration that only shows up after they are home. Targeted monitoring for this subgroup could be the next logical refinement of the pathway.

Some associations in the data resist easy explanation and the authors urge caution. Higher World Health Organization tumour grade and IDH wildtype status were both linked to a greater likelihood of early discharge, a counterintuitive result the team attributes to unmeasured confounding or selection effects rather than any biological mechanism. Posterior fossa tumours, located at the base of the skull near brainstem structures, also proved difficult: only nine of 25 such patients achieved POD1 discharge, and the rest averaged eight days in hospital. Meanwhile, the absence of a significant link between WHO Performance Status and discharge timing likely reflects the fact that patients with poor functional status were screened out of the pathway before the analysis even began.

Not every barrier to early discharge was medical. Among patients with no adverse events, no deficits and no imaging delays, prolonged admission was mostly attributable to waiting for physiotherapy and occupational therapy clearance — an operational bottleneck rather than a clinical one. Delayed post-operative MRI, which in principle should gate same-day discharge, affected only five patients in the entire cohort, with 98.1 percent of scans completed within 24 hours. The lesson for hospitals hoping to copy the model is that early discharge is as much a systems-engineering problem as a surgical one: it requires allied health assessment, imaging capacity and telephone follow-up infrastructure to move in lockstep with the operating theatre.

The limitations of the study are real. It is retrospective, so patients were never randomly assigned to early or prolonged discharge, and the 55.5 percent who went home on day one were by definition a selected, healthier subgroup. Only 21 readmission events occurred, yielding wide confidence intervals, and the analyses were univariable, leaving open the possibility of residual confounding. The authors do not claim equivalence between discharge strategies; they claim something narrower and more defensible — that in carefully chosen patients, structured day-one discharge is achievable without an observed rise in short-term readmission, and that the barriers to it are identifiable and, in many cases, modifiable. As neuro-oncology caseloads grow and hospital beds become scarcer, the ability to safely compress recovery into 24 hours offers a rare win on three fronts at once: better patient flow, lower cost, and the chance for people facing a life-limiting diagnosis to heal where most of them would prefer to be — at home.

Subject of Research: Feasibility and safety of post-operative day one discharge after craniotomy for brain tumour resection

Article Title: Post-operative day one discharge following craniotomy for tumour resection

Article References: Yogeswaran, K., Ewbank, F., Khoo, R., O’flaherty, D., Islam, M., Kaldas, A., Zafar, A., Durnford, A., Grundy, P., & Roach, J. (2026). Post-operative day one discharge following craniotomy for tumour resection. Journal of Neuro-Oncology, 179(3), Article 99. https://doi.org/10.1007/s11060-026-05790-2

Image Credits: AI Generated

DOI: 10.1007/s11060-026-05790-2

Keywords: craniotomy, brain tumour, neuro-oncology, early discharge, readmission, enhanced recovery, length of stay, neurosurgery, eloquent cortex, POD1 discharge, Post-operative, discharge