Predictors of prolonged length of stay in patients undergoing laser interstitial thermal therapy for intracranial tumors.

Purpose: Laser interstitial thermal therapy (LITT) offers a minimally invasive approach for treating intracranial pathologies while offering shorter length of stays (LOS) as compared to traditional craniotomies. Yet, some patients still face prolonged LOS (pLOS), highlighting the need to identify factors contributing to pLOS to improve outcomes.

Methods: We retrospectively reviewed patients who underwent LITT for intracranial pathologies at our institution from 2012 to 2023. Patients with LOS ≥ 75th percentile formed the study group, while those with LOS < 75th percentile formed control group. Patient demographics and perioperative factors were analyzed. Bivariate statistical analyses included Fisher's exact test, chi-square test, and t-tests. Univariate and multivariate logistic regression identified significant predictors of pLOS.

Results: Of 294 patients in this study, 73 patients in the study group (mean age 62.14 ± 11.63 years, 54.8% males) with a median LOS of 4.12 [IQR: 3.01-6.67] days were compared to 221 controls (mean age 59.50 ± 14.01 years, 40.3% males) with a median LOS of 1.92 [IQR: 1.86-2.01] days. Upon multivariate analysis, higher mFI-5 scores (OR 1.80; 95% CI [1.31-2.47]; p < 0.001), preoperative neurologic deficits (OR 2.27; 95% CI [1.09-4.76]; p = 0.029), and preoperative tumor volume (OR 2.03; 95% CI [1.46-2.83]; p < 0.001) were significantly associated with pLOS. Operative time, number of pullbacks, and extent of ablation were not significantly associated with pLOS (p > 0.05).

Conclusion: To our knowledge, this is the first study to identify preoperative mFI-5 score, neurological deficit, and tumor volume as independent predictors of pLOS in patients undergoing LITT for intracranial pathologies.