Postoperative care of the neurosurgical patient

Siegemund, Martin; Steiner, Luzius A.

doi:10.1097/aco.0000000000000229

Cited by 9 publications

(5 citation statements)

References 83 publications

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“…In the current era of informed consumers, healthcare ratings play an important role as a banner of quality to potential patients. Neurosurgery has embraced this theme of value and quality of care with many publications reporting the socioeconomic and quality aspects of neurosurgical care delivery [ 8 ]. Surprisingly, despite all the recent focus on S/SS at the national level neurosurgical literature is lacking on S/SS in the setting of craniotomy for tumor resection.…”

Section: Introductionmentioning

confidence: 99%

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Zhang

Pieters

et al. 2020

PLoS ONE

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Objectives Sepsis and septic shock are important quality and patient safety metrics. This study examines incidence of Sepsis and/or septic shock (S/SS) after craniotomy for tumor resection, one of the most common neurosurgical operations. Methods Multicenter, prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to identify patients undergoing craniotomy for tumor (CPT 61510, 61521, 61520, 61518, 61526, 61545, 61546, 61512, 61519, 61575) from 2012–2015. Univariate and multivariate logistic regression models were used to identify risk factors for S/SS. Results There were 18,642 patients that underwent craniotomy for tumor resection. The rate of sepsis was 1.35% with a mortality rate of 11.16% and the rate of septic shock was 0.65% with a 33.06% mortality rate versus an overall mortality rate of 2.46% in the craniotomy for tumor cohort. The 30-day readmission rate was 50.54% with S/SS vs 10.26% in those without S/SS. Multiple factors were identified as statistically significant ( p <0.05) for S/SS including ascites (OR = 33.0), ventilator dependence (OR = 4.5), SIRS (OR = 2.8), functional status (OR = 2.3), bleeding disorders (OR = 1.7), severe COPD (OR = 1.6), steroid use (OR = 1.6), operative time >310 minutes (OR = 1.5), hypertension requiring medication (OR = 1.5), ASA class ≥ 3 (OR = 1.4), male sex (OR = 1.4), BMI >35 (OR = 1.4) and infratentorial location. Conclusions The data indicate that sepsis and septic shock, although uncommon after craniotomy for tumor resection, carry a significant risk of 30-day unplanned reoperation (35.60%) and mortality (18.21%). The most significant risk factors are ventilator dependence, ascites, SIRS and poor functional status. By identifying the risk factors for S/SS, neurosurgeons can potentially improve outcomes. Further investigation should focus on the creation of a predictive score for S/SS with integration into the electronic health record for targeted protocol initiation in this unique neurosurgical patient population.

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Section: Introductionmentioning

confidence: 99%

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Zhang

Pieters

et al. 2020

PLoS ONE

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“…The criteria for post-operative admission to ICU, high-dependency unit or a specialized neurosurgical ward vary from institution to institution depending on local structures and characteristics of the available resources [27,28]. We propose a summary of criteria for ICU admission (Table II).…”

Section: Discussionmentioning

confidence: 99%

Criteria for Intensive Care admission and monitoring after elective craniotomy

Badenes

Prisco

Maruenda

et al. 2017

Current Opinion in Anaesthesiology

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“…It is therefore important to monitor closely for signs of postoperative haemorrhage, particularly intracranial haemorrhage (ICH). Which can occur in 1-3% of cases with mortality rates as high as 30% (Siegemund & Steiner, 2015). Neuro critical care nurse specialists can positively affect the mortality rate by identifying signs of neurological deterioration early, alerting the neurosurgical team and preparing the patient for surgery.…”

Section: Early Recovery and Rehabilitation After Decompressive Craniectomymentioning

confidence: 99%

Malignant middle cerebral artery infarct: A clinical case report

Leung

Jala

Elliott

2018

Australasian Journal of Neuroscience

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Background: Ischaemic stroke accounts for 87% of strokes and occurs when a clot or a thrombus blocks a blood vessel, cutting off blood flow to a part of the brain. If large areas of brain are affected, spaceoccupying oedema may result, leading to rapid neurological deterioration, coma and death. Malignant middle cerebral artery infarction (MMCAI) is a life-threating ischaemic stroke involving the whole middle cerebral artery (MCA) territory and comprises up to 10% of MCA infarctions. Methods: We report the case of a 62 year old female 'Mary' who presented with a MMCAI together with a summary of the most recent and relevant evidence for treatment options in terms of survival and quality of life for her. We also focus on the vital role of the nurse in Mary's care and treatment. Results: Intravenous thrombolysis and endovascular clot retrieval (ECR) during the hyperacute phase have been shown to improve outcomes but Mary did not meet the criteria for thrombolysis and received unsuccessful ECR. Her neurological condition deteriorated so she underwent surgical decompression, which is one of the major advances for MMCAI treatment together with expert neuro critical care nursing. Mary made a good functional recovery, returning home to live independently. Conclusion: This case highlights the need to consider all contextual and patient preferences in relation to treatment options. In addition the case emphases the vital role the neuro critical care nurse specialist plays in the complex assessment and treatment of this patient who experienced a MMCAI and underwent complex interventions.

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Postoperative care of the neurosurgical patient

Abstract: Although strong evidence is lacking, multimodal monitoring is of great value in neurocritical care patients and may help to provide patients with the optimal therapy based on the individual pathophysiological changes.

Cited by 9 publications

References 83 publications

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Criteria for Intensive Care admission and monitoring after elective craniotomy

Malignant middle cerebral artery infarct: A clinical case report

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