Background The determination of extubation (early or delayed) after pediatric craniotomy for intracranial tumor should be carefully considered because each has its pros and cons. The aim of this study was to investigate the incidence of the delayed extubation in these patients. The secondary goal was to identify the perioperative factors influencing the determination of delayed extubation. Methods This retrospective study was performed in pediatric patients with intracranial tumor who underwent craniotomy at a university hospital between April 2010 and March 2020. Preoperative and intraoperative variables were examined. The variables were compared between the delayed extubation and early extubation group. Results Forty-two of 286 pediatric patients were in the delayed extubation group with an incidence of 14.69%. According to multivariate analyses, the risk factors that prompted delayed extubation were the intracranial tumor size ≥ 55 mm (adjusted odds ratio [AOR], 2.338; 95% confidence interval [CI], 1.032–5.295; p = 0.042), estimated blood loss (EBL) ≥ 40% of calculated blood volume (AOR, 11.959; 95% CI, 3.457–41.377; p < 0.001), blood transfusion (AOR, 3.093; 95% CI, 1.069–8.951; p = 0.037), duration of surgery ≥ 300 minutes (AOR, 2.593; 95% CI, 1.099–6.120; p = 0.030), and completion of the operation after working hours (AOR, 13.832; 95% CI, 2.997–63.835; p = 0.001). Conclusions The incidence of delayed extubation after pediatric craniotomy was 14.69%. The predictive factors were the size of tumor ≥ 55 mm, EBL ≥ 40% of calculated blood volume, blood transfusion, duration of surgery ≥ 300 minutes, and completion of surgery after routine working hours.
A bstract Background Postoperative intensive care unit (ICU) admission is routinely practiced in pediatric and adult craniotomy. This study aims to identify the factors associated with an ICU stay of more than one day (prolonged ICU stay, PIS) after pediatric brain tumor surgery. Methods Medical records of children who underwent craniotomy for brain tumor during a 10-year period were reviewed and analyzed. Perioperative variables were examined and compared between the one-day ICU stay (ODIS) and PIS groups. Results A total of 314 craniotomies performed on 302 patients was included. Patients requiring postoperative ICU care for more than a day represented 37.9% of the sample. Significant factors found in the multivariate analysis affecting prolonged ICU length of stay included operative time ≥360 minutes (adjusted odds ratio [AOR], 2.438; 95% confidence interval [CI]: 1.223–4.861; p = 0.011), presence of an endotracheal (ET) tube (AOR, 7.469; 95% CI: 3.779–14.762; p < 0.001), and external ventricular drain (EVD) at ICU admission (AOR, 2.512; 95% CI: 1.458–4.330; p = 0.001). Conclusion While most children undergoing a craniotomy for brain tumor need a postoperative ICU care of ≤1 day, slightly more than a one-third in our study stayed longer. The prediction of a PIS can be beneficial for optimal resource utilization, increasing ICU bed turnover rate, reduction of operation cancellation, and improved preparation for parent expectations. How to cite this article Sangtongjaraskul S, Lerdsirisopon S, Sae-phua V, Kanta S, Kongkiattikul L. Factors Influencing Prolonged Intensive Care Unit Length of Stay after Craniotomy for Intracranial Tumor in Children: A 10-year Analysis from a University Hospital. Indian J Crit Care Med 2023;27(3):205–211.
OBJECTIVE A pediatric craniotomy for intracranial tumor removal brings both high bleeding and blood transfusion risks. The aim of this study was to identify the risk factors for intraoperative blood transfusion in this procedure. The secondary outcome was to investigate postoperative complications and clinical outcomes related to blood transfusion. METHODS A retrospective analysis was performed among children who underwent a craniotomy for brain tumor resection at a tertiary hospital over a 10-year period. The pre- and intraoperative variables were examined and compared between the transfusion and nontransfusion groups. RESULTS One hundred seventy-two patients (58%) received intraoperative blood transfusions among a total of 295 craniotomies in 284 children. Factors associated with blood transfusion were body weight ≤ 20 kg (adjusted odds ratio [AOR] 5.286, 95% confidence interval [CI] 2.892–9.661; p < 0.001), American Society of Anesthesiologists (ASA) physical status III–IV (AOR 6.860, 95% CI 1.434–32.811; p = 0.016), preoperative hemoglobin ≤ 11 g/dl (AOR 3.610, 95% CI 1.406–9.265; p = 0.008), tumor size ≥ 45 mm (AOR 2.117, 95% CI 1.214–3.693; p = 0.008), and duration of operation ≥ 6 hours (AOR 3.816, 95% CI 1.736–8.385; p = 0.001). Postoperative infection of other systems, other complications, duration of mechanical ventilation, and intensive care unit and hospital length of stay were found to be significantly higher in the transfusion group. CONCLUSIONS Lower body weight, higher ASA physical status, preoperative anemia, large tumor size, and prolonged duration of surgery were found to be significant factors for predicting intraoperative blood transfusion in pediatric craniotomy. The identification and modification of risks from intraoperative blood transfusion can be beneficial in reducing the probability of transfusion and improving allocation efficiency of limited blood component resources.
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