THIS refers to the report `Awake brain surgery with shortest stay at Islamabad hospital sets the bar high` (Aug 15) regarding brain tumour surgery, which, professionally speaking, may mislead the masses as it has left unchallenged some potential hazards.

It was a technical subject and views of independent professionals related to the relevant discipline might have come handy. According to the report, a surgeon has claimed that `awake craniotomy` that he practices is a new procedure. The fact is that it is as old as neurosurgery itself.

During my training at the Jinnah Postgraduate Medical Centre (JPMC) in Karachi three decades ago, I had assisted a senior professor during a number of such operations.

Indeed, the procedure has become more common in recent years across Pakistan.

What indeed is new is the `same-day discharge` following the surgery, particularly in health systems where insurance-payers dominate the scene.

However, the perils of foregoing close, in-hospital observation during the first 24 to 48 postoperative hours of heightened risk must be balanced against the economic gain of early discharge. Those who indulge in such a practice do so under strict guidelines in a limited range of tumour surgeries.

In a recent report on the subject from the University of Miami in the United States, only 32 of the 337 patients undergoing brain tumour surgery were considered for same-day discharge, and were sent out with elaborate riskmitigation health system procedures in place.

To suggest that discharging brain tumour patients on the day of the surgery itself should be a widely embraced management goal is, at best, negligent, particularly in weak health systems, as is the case in Pakistan, and would put patients at the risk of postoperative tragedy.

Dr Akbar Ali Bhand Head of Department of Neurosurgery Benazir Bhutto Medical University Larkana