Predictors of Prolonged Hospital Stay After Craniotomy for Tumor Resection

<title>Abstract</title> <p>Purpose: Prolonged length of hospital stay (LOS) after craniotomy for tumor resection is associated with increased healthcare costs, resource utilization, and postoperative morbidity. Identifying patients at risk for prolonged hospitalization may facilitate perioperative optimization and targeted discharge planning. This study aimed to identify predictors of prolonged inpatient hospital stay following craniotomy for brain tumor resection at a tertiary care center in a low- and middle-income country. Methods: A retrospective cohort study was conducted on 390 adult patients who underwent craniotomy for brain tumor resection at a single tertiary care center. Prolonged LOS was defined as hospitalization for ≥ 8 days. Demographic, clinical, radiological, operative, and postoperative variables were analyzed using univariate and multivariable logistic regression to identify independent predictors of prolonged LOS. Results: Of the 390 patients, 58 (14.9%) had prolonged hospitalization. On univariate analysis, prolonged LOS was associated with longer SCU/ICU stay, lower Karnofsky Performance Status (KPS), lower Glasgow Coma Scale (GCS), preoperative antiplatelet/anticoagulant use, greater blood loss, longer operative duration, perioperative transfusion, and general anesthesia. On multivariable analysis, emergency admission (OR 2.85, 95% CI 1.33–6.07), transfer from another service (OR 6.07, 95% CI 1.04–35.43), and longer operative duration independently predicted prolonged LOS, while higher preoperative KPS was protective. Conclusion: Emergency admission, inter-service transfer, prolonged operative duration, and poor preoperative functional status were independent predictors of prolonged hospital stay after craniotomy for tumor resection. Optimizing functional status, improving operative efficiency, and implementing enhanced recovery pathways may help reduce LOS and improve resource utilization.</p>