Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

Bui, J.; Mendis, Rajith; Gelder, James M. van; Sheridan, Mark; Wright, Kylie M.; Jaeger, M.

doi:10.3171/2011.8.jns11105

Cited by 81 publications

(78 citation statements)

References 12 publications

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“…Beauregard and Friedmann 6 reported that 2 of 132 patients required ICU admission from the floor after craniotomy. Similarly, Bui et al 5 reported 10 response calls among 343 elective craniotomy patients, none of which resulted in ICU transfer. Clearly, patients with some neurologic interventions can be safely observed in a general ward, and the safety of this practice among patients undergoing elective aneurysm treatment is shown for the first time in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on neurosurgical patients after craniotomy have suggested that ICU care after craniotomy may not be necessary. 5,6 Zimmerman et al 7 conducted a multicenter analysis of 3000 patients admitted to ICU care for neurosurgical diseases and found that among patients who were only observed in the ICU, Ͻ10% were likely to need any ICU treatments. Their analysis highlighted the need for comprehensive admission guidelines to the ICU.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms?

Burrows¹,

Rabinstein²,

Cloft

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY: Routine intensive care unit monitoring is common after elective embolization of unruptured intracranial aneurysms. In this series of 200 consecutive endovascular procedures for unruptured intracranial aneurysms, 65% of patients were triaged to routine (non-intensive care unit) floor care based on intraoperative findings, aneurysm morphology, and absence of major co-morbidities. Only 1 patient (0.5%) required subsequent transfer to the intensive care unit for management of a perioperative complication. The authors conclude that patients without major co-morbidities, intraoperative complications, or complex aneurysm morphology can be safely observed in a regular ward rather than being admitted to the intensive care unit. ABBREVIATION: ICU ϭ intensive care unit

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms?

Burrows¹,

Rabinstein²,

Cloft

et al. 2013

AJNR Am J Neuroradiol

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“…Prospective studies from different practices are needed to establish predictive factors to preoperatively and intraoperatively identify patients who would benefit from selective ICU admission. 5,9,54 In Group 3 in the present study, safe orientation of selected patients to more cost-efficient bed allocations contributed to significant cost reductions.…”

Section: Targeting Bed Assignmentmentioning

confidence: 86%

“…26 Recently, studies have documented the safety and feasibility of direct ward admissions for patients undergoing elective craniotomies, reserving ICU admissions for selected patients needing intensive care. 9,51,54 As ICU resources become more limited, this paradigm change will become more prevalent. In the present study, the care for most patients in the ICU consisted of intense monitoring, not intense care, except for one patient who developed postoperative parotitis and needed reintubation for airway protection within 4-6 hours after arrival in the ICU.…”

Section: Targeting Bed Assignmentmentioning

confidence: 99%

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

McLaughlin¹,

Upadhyaya²,

Buxey³

et al. 2014

JNS

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H ealtH care expenditures in the US continue to rise annually, faster than the national income. In 2010, health spending exceeded 17% of the nation's gross domestic product. 23,29 Numerous elements of national health reform are aimed at cost containment. Importantly, "bending the cost curve" refers most commonly to the government or insurers' payment to providers. However, reducing reimbursements does not decrease the cost of care delivery. The critical issue is how to deliver improved outcomes at the lowest cost and achieve the highest value of care. 41 Although health care providers have put significant effort into the quality and safety of care delivered in the past decade, little attention has been focused on cost measurement and even less on cost containment. This oversight stems from the fact that health systems, departments, and individual physicians misunderstand the costs related to the care they deliver.Early in 2009, the Department of Neurosurgery at our institution, aiming to improve the delivery of neurosurgical care, launched a Clinical Quality Program.2 Numerous improvement processes aimed at optimizing preoperative, intraoperative, and postoperative patient care were implemented by the third quarter of 2009. Previously, we assessed whether the multidisciplinary and multifaceted efforts instituted in 2009 succeeded in improving our delivery of value-based neurosurgery. 2,32 For that initial case study, patients undergoing microvascular decompression (MVD) performed by one neurosurgeon (N.A.M.) was the proposed model given that the surgical technique was standard, anticipated operative risks were relatively predictable, and perioperative care was relatively similar between cases. We documented a favorable impact from Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaObject. Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives.Methods. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all...

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“…The most feared complications after craniotomy are intracranial hematoma formation on the surgical site and cerebral edema as a result of surgical trauma, leading to an increase in intracranial pressure. (5)(6)(7)(8)(9)(10) The performance of a bedside neurological examination is one of the possible evaluations for early detection of intracranial hypertension.…”

Section: %mentioning

confidence: 99%

Interferência e características do edema periorbital no exame pupilar após craniotomia

2015

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Objective: To assess the interference and the characteristics of periorbital edema in pupil examination with patients who underwent anterior craniotomy. Methods: Prospective cohort study conducted postoperatively in an intensive care unit and neurosurgery ward. Interference and characteristics of periorbital edema in pupil examination were assessed between patients' admission and the seventh day of the postoperative period. Pupil examination was performed by nurses. Results: One hundred patients were examined and the incidence of periorbital edema was 80%. Pupil examination was not performed by a nurse in 24 patients (30%). The characteristics that influenced the performance of pupil examination were purplish coloration and severe periorbital edema. Conclusion: Periorbital edema was found in most postoperative craniotomy patients and pupil examination was not performed in 30% of them. The presence of severe periorbital edema and purplish coloration were the factors that hampered pupil examination. ResumoObjetivo: Avaliar a interferência e características do edema periorbital no exame pupilar, em pacientes submetidos a craniotomia por via anterior. Métodos: Estudo de coorte prospectivo realizado em pacientes no pós-operatório na unidade de terapia intensiva e internação de neurocirurgia. A interferência e características do edema periorbital no exame pupilar foram avaliados da admissão do paciente até sétimo dia de pós-operatório. O exame pupilar foi realizado por enfermeiros. Resultados: Foram avaliados 100 pacientes e a incidência de edema periorbital foi de 80%. O enfermeiro não realizou o exame pupilar em 24 (30%) pacientes. As características que influenciaram na realização do exame pupilar foram coloração arroxeada e intenso edema periorbital. Conclusão: O edema periorbital estava presente na maioria dos pacientes no pós-operatório de craniotomia e o exame pupilar não foi realizado em 30% dos pacientes. A presença de intenso edema periorbital e de coloração arroxeada foram características que prejudicaram o exame pupilar.

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Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

Cited by 81 publications

References 12 publications

Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms?

Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms?

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

Interferência e características do edema periorbital no exame pupilar após craniotomia

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