DOI: 10.1227/neu.0000000000004230 ISSN: 0148-396X

National Trends in Short-Stay Pediatric Neurosurgery: A Procedure-Specific Analysis Between 2016 and 2024

Caleigh S. Roach, Belen Wertheimer, Khushi H. Shah, Victor M. Lu, Sandi K. Lam
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BACKGROUND AND OBJECTIVES:

Short-stay (length of stay ≤1 day) pediatric neurosurgery has expanded through minimally invasive techniques, enhanced recovery pathways, and protocol standardization, but procedure-level evolution remains undescribed. We characterized the most recent national trends and 30-day safety in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric registry.

METHODS:

Pediatric neurosurgical operations (2016-2024) were classified into 16 categories by principal Current Procedural Terminology code. Cochran–Armitage trend tests with Benjamini–Hochberg correction quantified per-category temporal change; multivariable logistic regression with year × category interaction tested trend heterogeneity. Thirty-day safety was characterized overall and within the short-stay cohort.

RESULTS:

Across the 114 733-case cohort, 32 309 operations (28.2%) met the prespecified short-stay definition, and 7400 (6.5%) involved same-day discharge. The overall short-stay rate rose modestly from 27.8% to 29.9% (Cochran–Armitage Z = 4.50, P < .001; +0.23 percentage points per year [pp/yr]) but masked divergent procedure-specific trajectories (likelihood ratio χ 2 283.2, df = 14, P < .001 for year × category interaction). Single-suture craniosynostosis short-stay rose from 34.7% to 58.8% (slope +3.25 pp/yr; q < 0.001), complex or multi-suture craniosynostosis from 4.1% to 15.9% ( q < 0.001), Chiari decompression from 5.2% to 11.1% (q < 0.001), and vascular surgery from 1.9% to 6.1% ( q = 0.022); shunt revision declined (38.5%-35.9%; q = 0.039). Short-stay craniosynostosis was concentrated in infants younger than 6 months (88.0%). Over the study period in the short-stay cohort, major 30-day complications (1.0%; P = .883) and mortality (0.21%) remained stable, while unplanned readmissions (−0.10 pp/yr; P = .049) and reoperations (−0.13 pp/yr; P < .001) declined.

CONCLUSION:

The modest field-wide increase in short-stay pediatric neurosurgery conceals a more-than-doubling of short-stay craniosynostosis and Chiari decompression, with stable 30-day outcomes, identifying both as priorities for prospective, patient-centered protocol standardization.

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