Same Day Discharge Pathway in DBS Electrode Placement Surgery

Introduction: Deep Brain Stimulation (DBS) surgery faces increased demand due to the aging population, and limited inpatient hospital resources continues to restrict its access. To conserve hospital resources and enhance patient access, a move toward same-day discharge is emerging. This pathway has been deemed safe, yet evaluation of pre-operative factors to determine patient suitability remains unexplored. Our study retrospectively evaluates two cohorts – those discharged same-day and those staying overnight – to identify predictors for same-day discharge eligibility. Additionally, we report our institution’s workflow for ensuring appropriate reimbursement for same-day discharge, given its classification under the Center for Medicare and Medicaid Services (CMS) Inpatient Only (IPO) list.

Methods: This study included 60 DBS surgeries from 56 patients who underwent DBS implantation between January 1, 2022 and July 1, 2024, with 26 discharged the same day and 34 staying overnight. Logistic regression models were employed to explore the relationships between patient characteristics and the likelihood of same-day discharge. Additionally, we conducted a manual review of revenue and transaction data to understand reimbursement patterns.

Results: Diabetes (OR 0.078; 95% CI 0.009-0.679) significantly decreased odds of same-day discharge, whereas BMI (odds ratio [OR] 1.122; 95% confidence interval [CI] 1.002-1.256) was associated with higher odds. One patient in the same-day discharge group and two patients in the overnight group were readmitted due to complications. Reimbursement analysis showed a payment rate of 98.4% for overnight patients and 77.8% for those discharged same-day. Insurance denied coverage for one patient in the overnight group, with no denials in the same-day discharge group.

Conclusion : This study identified diabetes and BMI as potential factors to determine same-day discharge eligibility following DBS. The low complication rate in the same-day discharge pathway supports its safety. Despite reimbursement concerns due to the IPO listing of DBS surgeries, our institution’s effective workflow optimization showcases a model for overcoming financial barriers. This research advances the dialogue on enhancing DBS surgery discharge pathways, suggesting the viability of outpatient models with appropriate policy and practice modifications.