Establishing stereotactic brain biopsies in outpatient care as the gold standard: an argument for enhanced accessibility and patient-centric medicine.

Stereotactic brain biopsy is a fundamental procedure in neurosurgery that enables the histomolecular diagnosis of brain tumors and cryptogenic neurological diseases. Traditionally, this procedure requires hospitalization because of potential complications, particularly hemorrhagic events. However, the increasing emphasis on ambulatory surgery and its medico-economic benefits have led to the exploration of outpatient stereotactic brain biopsies. This study aimed to evaluate the safety and feasibility of outpatient stereotactic brain biopsy in a large, real-world patient cohort. This retrospective study analyzed all adult patients who underwent stereotactic brain biopsy at our institution between November 2021 and October 2024. We compared the outpatient and inpatient groups based on demographics, clinical and radiological data, biopsy characteristics, and post-procedure outcomes. The primary endpoints were the rate of unplanned hospitalization following biopsy (failure of outpatient management), biopsy-related complications, and unplanned medical consultations or admissions within 30 days after biopsy. Statistical analyses included univariate and multivariate models to assess factors influencing outpatient eligibility and outcomes. Among the 565 patients who underwent stereotactic brain biopsy, 191 (33.8%) were managed as outpatients. The same-day discharge success rate was 95.8%. Post-biopsy complications were comparable between the outpatient and inpatient groups (p = 0.97), with only one outpatient requiring unplanned hospitalization within 30 days (0.5%). Multivariate analysis identified factors favoring outpatient management, including low ASA scores, high Karnofsky Performance Status, shorter travel distances, and diagnoses of lower-grade gliomas. Patients aged ≥ 75 years and those with high-risk biopsy locations (e.g., brainstem) were successfully managed in an outpatient setting. Outpatient stereotactic brain biopsy is a safe and feasible approach for carefully selected patients, with high success rates and no increase in complication risks compared with inpatient management. This study supports expanding outpatient stereotactic brain biopsy as a standard practice, improving healthcare efficiency while maintaining patient safety.