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

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.