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Peer-reviewedCC BYJournal of neuro-oncology

Urgent versus scheduled resection in high-grade glioma: patient selection and healthcare utilization in a single-center cohort.

  • Danny A Mahmoudi1
  • Trent Kite2
  • Eric Singh2
  • Abigail McKenna1
  • Sami Shaikh1
  • Praveer S Vyas2
  • John Herbst3
  • Rodney E Wegner4
  • Stephen Karlovits4
  • Alexander Yu2
  • Alexander C Whiting2
  • Matthew J Shepard5
5 affiliations
  1. 1Drexel University College of Medicine, Philadelphia, PA, USA.
  2. 2Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, 320 E North Ave, Pittsburgh, PA, 15212, USA.
  3. 3Department of Neuro-oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
  4. 4Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
  5. 5Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, 320 E North Ave, Pittsburgh, PA, 15212, USA. [email protected].
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Abstract

Purpose

Patients with high-grade glioma reach surgery during the initial, index hospitalization (urgent), or through scheduled/outpatient pathways. There is a paucity of literature examining what patients require expedited versus elective surgery. This single-center retrospective study describes complications, utilization, and survival by pathway.Methods

Adults with WHO grade 3-4 gliomas undergoing primary resection (2021-2026) were classified as urgent (admitted without a planned resection date) or scheduled (discharged and readmitted for planned surgery, or managed exclusively as an outpatient). Primary outcomes were 30-day complications and days alive at home within 30 days of admission for resection (DAH-30). Secondary outcomes were progression free and overall survival. Survival was analyzed with propensity-score overlap weighting and Cox regression.Results

Of 166 patients, 122 underwent urgent resection and 44 scheduled resections; 40 of 44 (91%) proceeded as planned. Urgent patients more often had midline shift (62% vs. 32%), less often seizure (15% vs. 39%), and lower Karnofsky scores (70 vs. 80); all p ≤ 0.002. They had longer index hospitalizations (median 8 vs. 3 days, p < 0.001) and fewer days at home (median 15 vs. 27; adjusted difference - 8.9 days, 95% CI - 12.9 to - 4.8). Complication rates (36% vs. 30%; adjusted OR 1.15, 95% CI 0.52-2.62) and overall survival (median 15.4 vs. 19.0 months, p = 0.758) did not differ detectably.Conclusions

Scheduled resection identified a distinct population, recognizable at initial evaluation by preserved performance status and the absence of midline shift. These patients spent more days at home and required shorter hospitalizations; no harm signal was observed. These data suggest that a substantial proportion of patients with newly diagnosed presumed high grade gliomas can be managed effectively in an expedited, outpatient basis.

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Cite

BibTeXRIS
BibTeX
@article{mahmoudi2026urgent,
  title = {{Urgent versus scheduled resection in high-grade glioma: patient selection and healthcare utilization in a single-center cohort.}},
  author = {Danny A Mahmoudi and Trent Kite and Eric Singh and Abigail McKenna and Sami Shaikh and Praveer S Vyas and John Herbst and Rodney E Wegner and Stephen Karlovits and Alexander Yu and Alexander C Whiting and Matthew J Shepard},
  journal = {Journal of neuro-oncology},
  year = {2026},
  month = oct,
  doi = {10.1007/s11060-026-05841-8},
  url = {https://europepmc.org/article/MED/42911312},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Urgent versus scheduled resection in high-grade glioma: patient selection and healthcare utilization in a single-center cohort.
AU  - Danny A Mahmoudi
AU  - Trent Kite
AU  - Eric Singh
AU  - Abigail McKenna
AU  - Sami Shaikh
AU  - Praveer S Vyas
AU  - John Herbst
AU  - Rodney E Wegner
AU  - Stephen Karlovits
AU  - Alexander Yu
AU  - Alexander C Whiting
AU  - Matthew J Shepard
PY  - 2026
DA  - 2026/10/22
JO  - Journal of neuro-oncology
DO  - 10.1007/s11060-026-05841-8
UR  - https://europepmc.org/article/MED/42911312
AB  - Purpose  Patients with high-grade glioma reach surgery during the initial, index hospitalization (urgent), or through scheduled/outpatient pathways. There is a paucity of literature examining what patients require expedited versus elective surgery. This single-center retrospective study describes complications, utilization, and survival by pathway.Methods  Adults with WHO grade 3-4 gliomas undergoing primary resection (2021-2026) were classified as urgent (admitted without a planned resection date) or scheduled (discharged and readmitted for planned surgery, or managed exclusively as an outpatient). Primary outcomes were 30-day complications and days alive at home within 30 days of admission for resection (DAH-30). Secondary outcomes were progression free and overall survival. Survival was analyzed with propensity-score overlap weighting and Cox regression.Results  Of 166 patients, 122 underwent urgent resection and 44 scheduled resections; 40 of 44 (91%) proceeded as planned. Urgent patients more often had midline shift (62% vs. 32%), less often seizure (15% vs. 39%), and lower Karnofsky scores (70 vs. 80); all p ≤ 0.002. They had longer index hospitalizations (median 8 vs. 3 days, p < 0.001) and fewer days at home (median 15 vs. 27; adjusted difference - 8.9 days, 95% CI - 12.9 to - 4.8). Complication rates (36% vs. 30%; adjusted OR 1.15, 95% CI 0.52-2.62) and overall survival (median 15.4 vs. 19.0 months, p = 0.758) did not differ detectably.Conclusions  Scheduled resection identified a distinct population, recognizable at initial evaluation by preserved performance status and the absence of midline shift. These patients spent more days at home and required shorter hospitalizations; no harm signal was observed. These data suggest that a substantial proportion of patients with newly diagnosed presumed high grade gliomas can be managed effectively in an expedited, outpatient basis.
SN  - 0167-594X
SN  - 1573-7373
ER  -